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I: BE DONE ON PRIVATE PROPERTY L . ANY CONSTRUCTION ON THE PUBLIC
WILL REOUIRE
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DOMAIN (CURBS, SIDEWALKS, RI E PERS, MARQUEES, ETC.)
SEPARATE MISSION
STATE SURCHARGE
PERMIT APPLICATION:IS80 DAYS
T PERMIT LIMIT'. I YEAR - PROVIDED WORK STARTED "I HIN 180 DAYS
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFOR ANON
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S OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESO S
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INSPECTION FEE
ALL CILAIMS FOR DAMAGES OF W HATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
NOT BE
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS P ERMIT SHALL
CITY ORDINANCE
PLAN CHECK DEPOSIT
m 0 EMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY
, E 'S ANY ORDINANCE PROYISION -
RECEIlm
0 NOR LIMIT IN ANY WAY THE CITY ABILITY TO ENFORCE
TOTAL AMOUNT DUE
READ THIS APFLICATION� THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE
GIVEN IS CORRECT, AND THAT I A THE OWNER. OTATHE DULY.AUT"IFINI.ID POINT OF
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DATE SIGNEO
—SIGNATURE
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(OWNE
771-0220 RE EASED By ATE
EXT1333
IT IS UNLAWF U L TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI,
ORIGINAL FILE - YELLOW - INSPECTOR
- ASSESSOR
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..... . ...............
wall ..........................
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 ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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FINAL APPROVAL FOR VN-S
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'CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME
CITY
PERMIT EXPIRES
USE PERMIT
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JOB IUITIPTI
ADDRESS
PI -AT NAMEISU5QIVISION NO, LOT NO, I'D NO
LID FEE $
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YES 0 NO 0 F
REMARKS
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, TH15 PERMIT COVERS WORK TO
BE ... ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
G.A.I.G11ILL
.NFAJ. 'CUP.S. SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIR E
SEPARATE PERMISSION,
STATE SURCHARGE
PERMIT APPLICATI N: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFO MATION
F HIS OR HER SPOUSE, HEIRS. A SIGNS AND SUCCESORS
PLCANT, ON BEHAL o:NDEMNIFY. THE CITY OF
;AP
N TEREST. AGREES To DEFEND AND HOLDSHARMLESS
AGENTS FROM ANYAND
LANDSCA ING
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TSO FICIALS. EMPLOYEES, AND
a EIMONDS. WASHINGTON. F
ALL C E, ARISING DIRECTLY
LA1.SFoRDAMAGESOF WHATEVER NATUR
INSPECTION
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT $HALL NOT BE
PLAN CHECK DEPOSIT
DEEMED MODIFY. WAIVE OR REDUCE ANY REGUIREMENT 05 ANY CITY ORDINANCE
TO
ANY ORDINANCE PROVISION.-
PIECE
I NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE
TOTAL AMOUNT DUE
7�q o
THAT: HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
I HER95Y ACKNOWLEDGE
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHOR17ED AGENT OF
7hil Ippl-11- -1 11 , pjj unlit lignIn by th.
THE OWNER. [AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CON5TRUC-
CALL
Build, Officlal 11 -1- DGputy. nd P .1. d.
TION; AND IN DOING TH E WORK AUTHORIZED THEREBY, NO PERSON WI LL BE !IPLIIE D
WASHINGTON RE ATING TO
FOR INSPECTION
,irn I, .,k,=Iodg �iJn pb
IN VIOLATION OF THE LABOR CODE OF THE STATE OF
WORKMEN S COMPEY�ATION IN�RAN4 AND RCW I B.21
SIGNED
(425)DATE
771-0220-
EXT1333
-Aff ENTI-0 N
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 PILE YELLOW INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD -
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