20000395.pdfCITY OF EDMONDS �
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES
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VALUATION
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HE —AT SOURCE LOT SLOPE %
BUILDING
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PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK 1.
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIOEWALXS, DRIVEWAYS, MARQUEES. ETC.) WILL REOUIRE
SEPARATE PERMISSIOM
GR DINGIFILL
STATE SURCHARGE
PERIAITAPP"BAT`0 : IODDAYS
PERMIT LIMIT-. I YEAR . PROVIDED ORNK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG.REVIEW FEES
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF T Is PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
0 ENED TOMODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
'E 'S ASILITYTO ENFORCE ANYORDINANCE PROVISION,'
OR LIMIT IN ANY WAY THE CITY
1
JNqPE6TlG"lEE
P NCHECKDEPOSIT
TOTA AMOUNT WE
REC T
RECEIPT
IHERESY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION; THAT THE INFORMATION
GIVEN IS CORAECT.+ AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
CITY AND RE'Y 'PE R S G I IS Ruc�
OW STATE LAWS E UWAG CON
THE NER� I AGREE To COMPLY WITH N R ON WILL BE EMPLOYED
TION� AND IN 00 NG THE WORK AUTHORIZED THE
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN*S COMPENSATION INSU13ANCE AND ROW 18,27,
NATURE (OWNER OR G NT� DATE SIGNED
APPLICATION APPROVAL
P P in a p, I P,111 signed by In,
CALL A�nang aj,ja,o I,lhn.M I opid`y%ld Fees IM Paid, and
FOR INSPECTION ipt Is Ackllllldged in,peco P—ded.
OFFI IALS SIGNATURE DATE
(425)
Is
771-0220
ILEA DATE
ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
771-0221
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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REMARKS
0 N EWCONTRAETO' RESPONSIBLE FOR EROSION CONT ROUDRAINAGE
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EXP
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ALLOWED PROPOSED FRONT SIDE REAR
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CHANGE OF USE
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NUMBER NUMBER C,
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REMARKS
PROGRESS INSPECTIONS PER LED 108/FINAL INSPECTION REQ'D_�
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VALUATION I FEE
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PLUMBING
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ECHANICAL
I�
BE ON, 01, PR.IVATE PROPERTY 01411. ANY =NSTRUCTIONON THE PUBLIC
E'S , ET
..A", 'r EWALKS, DRIVEWAYS, MARQUEES C, WILLREQUIRE
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GRADINGIFILL
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SEPARATE PERMISSION.
TATE SURCHARGE
PERMIT APPLICATION 180DAYS
PERMIT UNIT: I YEAR � PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
-
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
'2
-AIPL16ANT, ON BEHALF 0 HI EVENS AND SUCCESORS
so" 8EI'spousE HE sL.A
IN INTEREST. AGREES TO NDE.NF,, DEFEND �N. NO HARMLESS THE CITY OF
12 EMPLOYEES. AND AGENTS FROM ANY AND
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EDMONDS, WASHINGTON. Ts OFFICIALS,
ESOFWHATEVER NATUPE� ARISING U - -
BE
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11- OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT
OF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
ORDINANCE PROVISION.'
RECEIPT
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPUCATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THECOWN15P FATTEEADULY AUTHORIZED AGENT OF
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ST W1 REGULATI
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THE OWNER� I AGREE TO COMPLY WITH � ING CONSTRUC.
PERSON WILL BE EMPLOYED
CALL
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TON; AND IN D NG THE WORK AUTHORIZED THEREBY, No
OOF STATE OF WASHINGTON RELATING TO
, ipt" �,k,,.AIPJ9�1 � �p p,d�
FOR INSPECTION
IN VIOLATION THE LABOR CODE OF THE
INSURANCE AND RCW 1817,
_
OFFIC A S SIGNATURE DATE
WORKMEN'S COMPENSATION .
OR SIGN..=
(425)
ATURE (( WINER FIE
_/
771-0210
.-
DATE
EL�A
EXT 333
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 - INSPECTOR
GOLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED, LED SECTION 109
FAX
PINK - OWNER
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Flats ming Wall ...........
0
Slab Insulation
PLUMBING:
Underground .............
M
Rough -In ...........
C:
1711
0
Commercial Final
0,
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HEATING:
Gas Test ................
—4
C
Gas Piping ...........
Equipment .................
commercial Final
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3:
EXTERIOR SHEATHING
At In
NAILING ..........................
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FRAMING . ............ —
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FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
Wall Insulation
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Ceiling Insulation
N,
SHEETROCK NAILING
Z
0
SPECIAL INSPECTION
M,
MISCELLANEOUS ..........
FINAL APPROVAL FOR
00
OCCUPANCY ..................
00373