20000340.pdfCITY OF EDMONDS �
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER E.PIRATI N DATE .BCK.. BY
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NOTE Is PERMIT COVERS WORK I
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SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION; ISO DAYS
S
PERMIT LIMIT. I YEAR * PROVIDED WORK I STARTED WITHIN 180 DAYS
S*
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
NIIIIALFOF HIS OR HER S;�O.U.SE HEI.R.SLABSAGNS AND SUCCESORS
OA �N G PILESS THE CITY OF
ENG. INSPECTION FEE
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771-0220
LEASE DATE
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EXT
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A OR STRUCTURE UNTIL
OCCUPY A BUILDING
771-0221
IT IS UNLAWFULTO USE OR R A CERTIFI-
BEEN MADE AND APPROVAL 0
ORIGINAL - PILE - YELLOW - INSPECTOR
ASSESSOR
A FINAL INSPECTION HAS
BEEN GRANTED. UBG SECTION 109
FAX
PINK - OWNER . GOLD �
CATE OF OCCUPANCY HAS
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
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Footing ......................
wall.1 ......................
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Pier/Porch .................
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Retaining Wall ...........
Stab Insulation ..........
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Gas Piping .................
Equipment _ ...............
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall insulation ..........
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Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
ATE RECEIV[D
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EXPIRES
CITY OF EDMONDS
JA
PERMIT
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Z NUMBER
CONSTRUCTION PERMIT APPLICATION
jo SUITE/AFTF
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BUSINESS
PLAT NAME/SUBDIVISION NO. LOTNO, L�DNO,
I
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED 00
REQUIRED DEDICATION— FT —
—FIXTURES
NAME I
METER SIZE LIKE SIT-7-F A- 01
I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTFIOIJDRAINAGE
CITY ZIP TELEPHONE
NAME
ADDRESS
ENGINEERING
to
CITY
FIRE REYEWEDIBY DATE
STATE LICENSE NUMBER EXPIRATION DATE
1 YAP(pNoIE6Acu SHORELINE OR AOSft INSPEC TtON
m
N NO
SERA REVIEW SIGN AREA H EIGHT,
NEW RESIDENTIAL PLUMBING I MECH
LOTCCNERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBATKS (FT.)
FRONT BEAR
ADDITION COMPLIANCE OR
NTAIE
io
DEMOLISH 0 TANK o OTHER
CA A ING WALL
-Ti
r (TYPE OF USE. BUSIN ESS OR ACTIVITY) EXPLA�IN:
NUMBER NUMBER F
70
CIITIIALA
OF DWELLINC AREAS _XM
SPECIAL INSPECTOR OCCUPANT
YES
DESCRE�E WORK TO BE DONE
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REMARKS
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PLAN CHECK FEE e�wz
'go
rn
ESfEb DATE
PLAN CHECK NO: ji C)
nE
PLUMBING 1,5n
THIS PERMIT AUTHORIZES ONLY THEW RKNOTED. THIS PERMIT COVERS WORK TO
MECHANICAL
AC2
t: BEDONEON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T E PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSIOM
STATE SURCHARGE
Ztz -y,�
PERMIT LIMIT-. I YEAR � 180 DAYS
PROVID 0 WORK IS STARTED WITHIN
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS.GR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTE 5 T. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CIT
ALL CILAIMS FOR DAMAGESOFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FED NFEE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY CITY ORDINANCE
IRECEIPT/ LLIIW,7
PLAN CHECK DEPOSIT
REQUIREMENT OF ANY
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
IR CEIPT 1'r-,
TOTAL AMOUNT DUE q
I HEREBY ACKNOWLEDGE TH HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN I ECT AND T, TIJAMTHE OWNER, ORTH DULY AUTHORIZED AGENT OF
THE OW E T IPLY WITH Ty AND STATE LAWS REGULATING CONSTRUC.
ZTHABOR
dby-
]ON. A� GTH ORKAUTHO ED THEREBY, NO PERSON WILL BE EMPLOYED
N VIOL, CODE OF THE STATE OF WASHINGTON RELATING TO
d��gOlf,,,,Illhil/h,,Doputy;,,dFA --d.
As
FOR INSPECTION
E==14TI I DATISIGNyf)
(425)
771-0220 DATE
L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK OWNER GOLD -ASSESSOR