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CITY OF EDMONDS
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
f DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
� SEPARATE PERMISSION.
URCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT.I YEAR- PROVIDED WORK IS STARTEO WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS ANO SUCCESORS
ENG. INSPECTION FEE
H IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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FROM THE ISSUANCE THIS PERMIT. ISSUANCE OF THIS PERMIT
ANACNC9 ORDINANCE
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TOTAL AMOUNT DUE
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APPLICATION APPROVAL
AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
I HEREBY ACKNOWLEDGE THAIC
This application is not a parmil until slgnetl by Ihp
GIVEN IS CORRECT,
COMPLY WITH CITY AND STATE LAWS REGULATING CON
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Building 011iciol prhlslher Deputy: Intl Foos l,,p.d. antl
THEOWNER.(AGREETO LO D
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RELATING TO
FOR INSPECTION
receipt 1s Ick—Ildgod Io Ipaca provided,
OEEBO'WASHINGTON
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771-0221
NPECT R
ORIGINALYELLOW-INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER •GOLD -ASSESSOR
5198
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
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CITY OF EDMONDS
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EXISTING PROPOSED e O
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❑ REMODEL ❑ APARTMENT ❑ SIGN
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FENCE
❑ REPAIR ❑ GRADING CVDS ❑ ( __ X FTI
REMARKS
-
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE ❑ ❑ ROCKNIN WALL ❑ RENEWAL CARPORT
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONSTRUCTION C DE
GROUP
NUMBER NUMBER OF CRITICAL
AREAS
SPECIAL INSPECTOR AR
OCCUPANT
OF DWELLER
STORIES UNITS NUMBER
REQUIRED ❑ YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 10SIFINAL INSPECTION RED'
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BUILDING
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PLAN CHECK NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT" AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE GONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRApINGIFILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC,) WILL REQUIRE
TT
SEPARATE PERMISSION.
,�A URCHARGE
W
PERMIT APPLICATION: iBO GAYS
PERMITLIMIT:I YEAR - PRDVIDEO WORK IS STARTEDW HIN IBBOAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFOR TION ;'
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;APPLICANT,
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AND
LANDSCAPING
cEDMONOS. WASHINGTON. ITSOFFICIALS, EMPLOYEES. AND FROM ANY
OR INDIRECTLY
INSPECTION FEE
= ALL CLAIMSFOR DAMAG ES OFWHATEVER NATURE, ARISING DIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIB PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
GEEMED TO MOOIFV, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_ NOR LIMIT IN ANY WAYTHE CITY'S AS TO EN FORCEANY ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
RECEIPT r
L 7�S
ryry,,
I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
HEREBY ACKNOW LEDGE THAT
GIVEN IS C.P.ECT: AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
TNis applical�pn �s nPl a pormil unpl aiBn0 by Idp
THE OWNER. AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Buildm0011,11.1 or NislNar DOPp1Y and Foos arp paid, and
V
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
pcpipl m ucMnpwlod9otl in .pncP p P_'d.
IN VIOLATION OF THE LABOR CODE OF THE STATE
AND Rf.W 18.27.
SIGNA RE DATE
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WOKMEN'S
COMPENSATION INSURANCE
(425)
OFFICIALS
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DATE EI NE
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,I
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DATE
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771-0220
nE,EAsE Y
EXT 333
t ATTEN
ION
I IT IS UNLAIVFULTO
USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1-
A FINAL INSPECTION
HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL � FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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