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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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'�AILING ADDRESS
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CITY I TEL�IVE
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MECHANICAL
THIS -PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
CONSTRUCTION ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY. ANY
SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REOUIRE
OR DINGIFII-L
DOMAIN (CURBS.
SEPARATE PIERMISSION�
STATE SURCHARGE
PERMIT APPLICATION:,,180 DAYS
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PERMIT LIMIT: I YEAR. p,olGll WORK STARTED WITHIN 180 DAYS
SSE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT. ON BEHALF OF HIS GRge,, SPE,�UEE PoS�ASSGNS AND SUCCESORS
�NDSIH THE CITY OF
DINDEM Er D HARMLESS
NNTE .. T AGREES T( AGENTS FROM ANY AND
I ANDSCAPING
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EE.oN.S WASHINGTON. ITSOIRCIALE.E.11LOYSES,AND
NATURE. ARISING D, NECTLIORINDIFECTLY
i ALLCLAIMS FOR DAMAGES OF WHATEVER, NO' HE
RECEIPT
SSUANCE OF ,,, PERMIT SHALL
FROM THE ISSUANCE OF THIS 'S RU F ANY CITY ORDINANCE
LAN CHECK DEPOSIT
EORREO.'EAKyFE.UtREMF,NT
DEEMEDTO MODIFY. WAII C
TOENFORCE ANY ORDINANCE PROVISION,`
NOR LIMIT IN ANYWAYTHE DRYS ABILITY
THAT I HAVE REAGT.,EAFpLK;ATI.N.TNATlHEINl RMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
IS CoR,RECTANDTHATIA.THEI T'NR OF THE CULY ALT..PIZEO AGENT OF
T'll - 11 "1 - 1-11 ` r-""
GIVEN N6 STATE LAWRGULATINGDoISTRUC-
TH5OWNER. AGREE TO COMPLY WITH CITY THEREBY, NO .Eo. WILL BE EMPLOYED
DOING THE WORK AUTHDR'lEl TO
C-puly Ild I,_ - PlId
TION ""T"'
TION. AND IN
IN VIOLATION OF THE LABOR CODE OF , A , STATE OF WASHINGTON RELATING
EAT
WORKMEN S CoMfENSATION INSURANCE AND RCW 18.27�
OF" L NATU
DATE SIGNED
(425)
SIGNATL5P;KINER 0
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771-0220
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EXT 333
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE - YELLOW --INSPECT.R
- GOLD - ASSESSOR
CATE OFIOCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wait..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in . ...................
Commercial Final
HEATING:
Gas Test .............
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ....................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
FINAL APPROVAL FOR ifk
OCCUPANCY ..................
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED/DATE
FIRE REVIEWED By DATE
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
t: E DONE N PRIVATE P'
DOMAIN (CUABS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
PLUMBING
MECHANICAL
GRADING1111-1.
STATE SURCHARGE
PEI MIT APPLICATION: 18D DAYS
PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEC SACK OF PINK PERMIT FOR MORE INI.RMAT ION
C
w P L T H F 0, SSGNS AND SUCCESORS
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. A
IN EREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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INT E E T I
T I s, EMPLOYEES, AND AGENTS FROM ANY AND
E.MONDS,WASH,NGTON ITSO FIVAL
S"' G 0
LLCLAIMS FOR DAMAGEiI OF WHATEVER NATURE. ARISING DIREC ORINDIRECTLY
A L CLAIM OR
FROM THE ISSUANCE OF THIS PERMIT. ISSU NCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF ,
,m DEENEDTOMODIFY. WAIVEOR REDUCE ANYREGUIREMENTOF ANYCITY ORDINANCE
0 1 Y W 'VE
o R LIMIT NANY WAY THE BILITYTO ENFORCE ANIORDINANCE PROVISION.'
0 NOR LIMIT INANYWAYTHE CITY -SA
E
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
LL,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT TIIE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT 01
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION. AND IN DOING THE WORK AUTHORIZED THE REBY. NO P E RSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COM�JE-SATION INSURANCE AND RCW 16.27
APPLICATION APPROVAL
h
CALL T , ppIj,, 1 a pej �.,ed by INO
dl,, hlslh,, DUpdl�y�. :P.d — d. ld
FOR INSPECTION ipt �llld ,d.,I.
OFFIP L NATU CAT
SIGNATURp��_NFR DATE IGNED
(425)
771-0220
HE By 0 E
C
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTI L
ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
EXT 333
771-0221
00
ORIGINAL - FILE YELLOW INSPECTOR
A FINAL INSP
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD - ASSESSOR
E.,9.