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CITY OF EDMONDS �
CONSTRUCTION PERMIT APPLICATION
OWNER NAME.AME OF BUSINESS
MAILING ADDRESS
CITY ZIP T E�l �N
ADDRESS
CITY
NAME
PERMIT EXPIRES
USE PERMIT
ZONE NumBER
JOB BLITZ
ADDRESS S�-
PLAT NAMEISUBDiVISION NO. LOT No'
UD NO.
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ
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PLAN JHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION)ON THE PUBLIC
GSADINGIFILL
DOMAIN (CURBS, SIDEWALKS. DRIVE AYS. MARQUEES, ETC WILL REQUIRE
m SEPARATE PERMISSION
STATE SURCHARGE
PERM IT APPLICATION: 18GOAVS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WIT HIN 181) DAYS
ENG. REVIEW FEES
S. BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF 0, HIS OR HER SPOUSE HERB�,.EIGNS AND SUCCES..S
�No H. HARMLESS THE CITY OF
END. INSPECTION FEE
LANDSCAPING
;APPLICANT.
N INTEREST, AGREES TO NDE."'Y. DEFEND
% OFFICIALS. EMPLOYEES� AND AGENTS FROM ANY AND
INSPECTION FEE
2 EDMo"`DjWARHAGToN
. F. . MA EjOFWHATEVER NATURE. ARISING DIRECTLYOR IN.IRECTLY
RECEIPT
ALLC,,.
'X FROM THE ISSUANCE OF THIS PERMIT. BSIAIIE 11 THIS PERMIT SHALL NOT BE
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PLAN CHECK DEPOSIT
11 DEEMED TO MODIFY. WAIVE 08 REDUCE AN REQUIREMENT OF ANY C ITI OPDINANC
PROVISION -
RECEIPT
0 NOR Ll MIT IN ANY WAY THE CITY'S ABILITY TO ENFO RCE ANY ORDINANCE
TOTAL AMOUNT DUE
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AppTLI.CEATIoN� THAT INS INFORMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVERE.AlW) TH,.S
T IE NE OR UL AUTHORIZED AGENT 01
ThIl IPP'Call- 11 Pa-'t "" by 1h.
GIIINWS CORRECTjIAND THATPILAM
To CON YW11!HOITY AN6 STATE LAWS REGULATING CONSTRUC-
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F.'o-
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S"Idb,l officl.1 .1 D.PuIV "
THE 0 NER I A.R
T E WORK AUTHORIZED THEREB No PERSON WILL BE EMPLOYED
ION, AND IN DOING TH Y' T 0
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FOR INSPECTION
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I N VIOLATION OF THE LABOR CODE OF THE STATE QF WASHINGTON RE ATING
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lORllElSCl"lEllAlIOl INSURANCE AND RCVV IB-21
OFFICIAL
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(425)
Se%�
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771-0220
REL-EASED By
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EXT333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
I
ORIGINAL FILE - YELLOW INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD -
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
will.............
Pier/Porch .................
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Retainlrig Wall ...........
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Slab Insulation ..........
PLUMBING:
.............
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Commercial Final
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Gas Test ....................
gas Piping ...............
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Equipment, ...............
Cc mercial Fin . al
M'M
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING � .......................
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FIRST FLOOR FRA MING
INSULATION ...................
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Floor Insulation
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Wall Insulation ...........
Ceiling Irisulatlon
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SHEETROCK NAILING
0
SPECIAL INSPECTION
1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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:LATE RECEIVED
Us' 'IT
PER
ZONE
CITY OF EDMONDS UMER
CONSTRUCTION PERMIT APPLICATION JOB S1ITEfAPT1
ADDRESS
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PI -AT NAMEISUBDIVISION NO. LOT NO, �D NO,
D FEE $
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II�ING ADD 1—F 0
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PUBLIC RIGHT OF WAY PER OMCIAL STREET MAP 0
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EXISTING — PROPOSED— -
CITY ZIP
ITELEPHONE
REQUIRED DEDICATION FT 0
METER SIZE 77w—Esiz E NO. OF FIXTURES PRV REQUIRED
AME
YES 0 NO C3
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ADDRESS REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP TELEPHONE
NAME
T k A ENGINEERING V E E
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FIRE REVIEWED By DATE
'TY ZIP TELEPHONE
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U FIANCE OR YU SHORELliTEbRAOBN INSPECTI N
VA
IPBOND
STATE LICENSE NUMBER 1IIECKE11Y , REO'Do OSTED
0 YES NO
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HEIGHT
SIGN AREA
PROPERTY TAX ACCOINTRARCILNO, COMPLETE EXEMPT ALLOWED PROPOSED
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COMMERCIAL C MPLIANCE OR 1
ADDITION CHANGE OF USE _:
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NUMBER 'U IER 11 GA OCCUPANT
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GY ELLIN. S
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OF LOAD
STO IES U N"I NUMBER REQUIl
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DESCRIBE WORK TO BE DONE
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REMARKS
PR GRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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VALUATION
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PLAN CHECK FEE
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HEAT SOURCE GLAZING I LOT SLOPE % BUILDING
PLAN VHECK NO: ... 11.D DATE PLUMBING m
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGiFILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES . ETC.) WILL REQUIRE
SEPARATE PERMISSION. S rATE SURCHARGE
PERM T APPLICATION: 160 DAYS
PROVIDED W RK IS STARTED WITHIN 10 DAYS ENG. REVIEW FEES
A. PERMIT LIMIT. 1 YEAR 0
PERMIT LIMIT I YEAR
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SEE BACK OF
ENG. INSPECTION FEE
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN IZTERE�l AGREES TO INDE.NIF1 DEIEN. AN. HOLD HARMIEBS — Cl I 1 -1 LANDSCAPIN
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO. ANYAND INSPECTION FEE
A LYORINDIRECTLY
- I
ALLCLAIMSFOR DAMAGESOF WHATEVER NAtURE.ARISING DIRECT RECEIPT
A
I
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMEDT. MODIFYWAIVEOR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 M.Dl Y V
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' EIPT
T Y W Y T. I
TOTAL AMOUNT D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
BIS
CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
GIVEN Thl, APPI-1-11, 11 - I Pull" unul u1p1d by thl
OW C CONSTRUC-
THE NEB. IAGREETO OMPLY WITH CITY AND STATE LAWS REGULATING CALL Pull: p.id. -d
WILL BE EMPLOYED B.ildu,g ffidlll h�� D
W Z
TION: ANDIN DOING THE ORKAUTHOR ED THEREBY, NO PERSON P-1d.u.
CODE OF THE STATE OF WASHINGTON RELAT?NG TO FOR INSPECTION
IN VIOLATION OF THE LABOR
WORKMENS COMPENSATION INSURANCE AND RCW 18,27, "'CIAI D
ENT E SIGNED (425)
�ELMEA
7 71
-0920
ATTENTION EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND AP ROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD ASSESSOR
8