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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURDS, SIDEWALKS, DRIVEWAY% MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STAT SURCHARGE
PERMIT APPLICATION; 180 DAYS
PERMIT LIMIT'. I YEAR . PROVIDED WORK 15 STARTED WITHIN 16D DAYS
ENG. REVIEW FEES
SEEBACKOFPI K PERMIT FOR MORE INFORMATION
PPLICANT, ON BEHALF OF HIS OR HER S'poUE, HEl.R.SASEI.NSAN.SUCCES.AS
XN CITY OF
ENG. INSPECTION FEE
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ISSUANCE OF THIS PERMIT SHA BE
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FROM THE ISSUANCE OF TH IS= NY REOUIREMENTOF ANY CITY
DEEMED To MODIFY. WAIVE OF A ORDINANC
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THIS APPTLIHCEATIULN�
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IN VIOLATI OR CODE OF THE STATE OF WA
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(425)
OFF IAL5 SI NATURE DATE
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771-0220
1
DATE
RELEASED
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 FIL E - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR
DATE AP PROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ..............
Commercial Flnal'm!
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ............
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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E ATE PERMISSION
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT, 1 YEAR 'PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
OF
IN NTlCRtElWT ITICT�0, �TC.E- FY DEFEND AND HOLD HARMLESS THE CITY
FROM ANY AND
=.
ED..N FF,i CIALS. EMPLOYEES, AND AGENTS
ARISING DIRECTLY OR INDIRECTLY
AULCLAIMSFOR DAMAGESOFINHAT VER NATURE,
THIS PERMIT. ISSUANCE OF THIS PERMIT SH�Ll NOT BE
FROM THE ISSUANCE OF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIN41T IN ANY WAY TH E CITY'S ABILITY TO EN FORCE ANY GRUINAh
-1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INF RMATION
AUTHORIZE. AGENT OF
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE OULY
CITY AND STATE LAWS RIGU LAI TING CONS"UC
THEOWNE I AGREE TO COMPLY WITH
R
I F. Y NO PER ON W 'L BE EMPLOY'
WORK AUTHORIZ D HE B
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TION; AND IN DING THE I,
IN VIOLATION OF�THE LABOR CODE OF TH STATE .1 AS 'N.T.N R ELA NO 1.
E
WORKMEN'S CqMPENSATION INSURANC5.4NO ROW 18.27
SIGIA I� A). EN�Frl,-
.,,,TIE
VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADINGI;ILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
— RECEIPT
TOTAL AMOUNT DUE
5-00
APPLICATION APPROVAL
I` .1pli ie ,I . P—it uhill 119tIld by the
CALL
.idllo 0111-10, IX ,,t1hDI D,p,ty: Ild Fell wo p d, ,d
FOR INSPECTION
foco!pl is acknowl0d9c,l � �p... F It_
OFF IALS SI TURE DATE
(425)
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771-0220
N LEASEDIII' DATE
ATTENTION r-Ai J,,;)
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTII. 771-0221 -- YELLOW INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR,AqCERTIFI- ORIGINAL 'ILE - GOLD -ASSES OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 0 FAX PINK - OWNER
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