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PERMIT EXPIRES
CITY OF EDMONDS
PERMIT
ZONE 45-6,00 NUMBER 200700
CONSTRUCTION PERMIT APPLICATION
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ADDRESS A/ �W/
OWNER NAMEINAME OF BUSINESS
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T THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
H S BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
PERMIT AUT"O RZS'
BE Do NE ON PRIVATE P
2 DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIAE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C
P LLC NT E P L
A PLLCANT. ON BEHALF, OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOnS
WW I N I NTERE "T , AGREE S TO INDEM�IFY, DEFEND AND HOLD HARMLESS THE CITY OF
I N NTEREST, AGREES
DS WASHINGTON'
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
�M4' ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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0 NOR LIMIT INANYWAY THE CITY
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REQUIRED 0 YES
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REMARKS
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ENO REVIEW FEES
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REC IPT
TO AL AMOUNT DUE
REC 17
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN I CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHO-ED AGENT OF
S
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THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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DATE
WORKMEN S COMPENSATION INSURANCE AND RCW 18.21.
(425)
OFFICIALS SIGNATURE
SIGNATURE (OWNER OR�A OT)
ATE SIGNED,,k,
771-0220
DAW
RELEASED By
74T�E "NT
EXT 333
10 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 FILEF- YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
FWIng ............ . ........
wall ......................
Pier/Porch .................
Retainirig 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
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Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTE., THIS PERMIT COVER WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
ORADINGIFILL
IRE
POMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
U CHARGE
PERMITAPPLICATI N; 180DAYS
FEES
PERMIT LIMIT',I YEAR - PRoVIDEOWORKIS,STARTEO WITHIN ISO DAY&
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
EN6. REVIEW
ON BEHALF OF HIS OR HER SPOUSE. HEIRS ASSIGNS AND SUCCESORS
CITY OF
ENG. INSPECTION FEE
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;APPLICANT
N INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE
EDMONDS, WASHINGTON. ITSOFFIMALS. EMPLOYEES. ANDAGENTS FROM ANY AND
INSPECTION FEE
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A CLAIMS FOR DAMAGES OF WHATEVER NATURE� ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THI S PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
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ANY CITY ORDINANCE
DEEMED To MoDIFY.WAIVEO REDUCE ANY REQUIREMENT OF —1-11
ANY ORDINA—L "I
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NOR LIMIT IN ANYWAY THE CITY*S ABILITY TO ENFORCE
TOTAL AMOUNT DUE
THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
=BY ACKNOWLEDGE
IS COB AND THAT I AM THE OWNER, OR TEE DUSyRAUTHDBLZED AGETRT OF
Thl. ppj,,At,. pjt �td 11,11d y lhl
THE OWNER. IRECT. LAW EGULA I G CONS UC
AGREE TOCOMPLI WITH CITY AND S
CALL
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ERE— DYED
TION. AND IN DO No THE WORK AUTHORIZED TH BY, No PERSON WILL BE EMPL
RELAT ING TO
i� wl.dg.�
FOR INSPECTION "'SE
IN VIOLATION STATE GF WASHINGTON
O'Ft THE LABOR CODE OF THE
WORKMEN SCOMPENSATION INSURANCE AADRCVV 18.27
IFICIAISSl..T.BE D;
DATE SIG D/A�
(425)
rNATIURE (OWNER C!�G �T)
771-0220
RELEASED By
—ATTENTION
EXT 333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION AS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAIL-FILE - YELLOW INSPECTOR
ASSESSOR
A
BEEN GRANTED. UBC SECTION 109
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