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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTEo. THIS PERM" COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
zi SEPARATE PERMISSION,
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2 MIT APPLICATION: 180 DAYS
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PERMIT LIMIT: 1 YEAR - PROVIDED WOR S STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOFS
THE CITY OF
W IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS
E DMONDS' WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AID
A.AGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALLCLAIMSFORD,
x FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO Y WAIVEOR REDUCE ANY REOUIREIVENTOI ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TOENPORCE ANYORDIN
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IHEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION. THAT I.E INFORMATION
GIVEN I S CORRECT, AND THAT I AM THE OWNER� OR THE DULY AUTHORI ED AGENT 01
THEOWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTF.0 -
TION, AND IN DO NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATI ON OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'SCOMPENSATION.INSU C A 0 RCW 18,27.
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
ORIGINAL -FILE YELLOW- INSPECTOR
A FINAL IN SPECTION AS BEEN MADE AND APPROVAL OR A CERTIFI PINK - OWNER GOLD - ASSE�SOR
CATE OF OCCUPANCYI'lilAS BEEN GRANTED. UBC SECTION 109 FAX
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retalnlrig Wall ...........
w;
Slab Insulation
PLUMBING:
Underground .............
Rough -in ...................
Final
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Commercial
HEATING:
Gas Test ....................
Gas Piping ............
E qui pment .................
M.
Commercial Final
F.
EXTERIOR SHEATHING
NAILING .....................
FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation ...........
c6ling Insulation
SHEETROCK NAILING
OR
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
FERMIT EXPIRES
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PERMIT v
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION IOB plUITEllPTl
ADDRESS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRAOINGIFLL
MAROUEES, ETC.) WILL REQUIRE
LKS, DRIVE AYS.
DOMAIN (CURBS, SIDEWA W
SEPARATE PERMISSION.
S CHARGE
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PERMIT LIMIT, I YEAR R=WO
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SEE BACK OF PINK PERMIT FOR MI
P F FHI POUSE, HEIRS, ASSIGNS AND SUCCESORS ENE. INSPECTION FEE
A PLICANT. ON BEHAL 0 S OR HER S
21 IN INTEREST, AGREES TO INDEMNI Fy' DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAP NO
ANY AND
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM INSPECTION FEE
ALL CLAIMS FOR DAMAGES 01 WH ATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY RECEIPT
FROM THE ISSUANCE OF THI S PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
�O DEEMED TOMODtFY.WAIVE ORREQUCE ANY REQUIREMENT OF ANY CITY ORDINAN E
ANY a ROMANCE PROVISION ' RECEIP
0 NOR LIMIT IN ANY WAYTHE CITY'S ASIUTY TO ENFORCE
TOTAL -AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLIC ION A �AL
"'o
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF .r
Thl, IPPI'l-till I� -t I P'll: :r B
THEO NER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUG- CALL di.g Offi-I ., bisihll Dapotv: F
L LIAPLOYED 0-k-l.dg. '-p-, .,I.
TION: AWND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WIL BEE T
RE ATING 0 FOR INSPECTION
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'SCOMPENSATION,INSU��.EANII R.- l..0. OFFICIALS SIGNA R(
(425) Li
I
771-0220 lELEAlEq,8'Y DATE
EXT 3313
—ATTeNTfON
iTISUNLAWFULTOUSEOR OCCUPY A BUILDING 08 STRUCTURELINTIL 771-0221
A FINAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW -INSPECT OF
I
PINK -OWNER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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