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PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION JOB
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PLAT NAMEISUBDIV;SION NO�
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NAME
METER SIZE
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NO.O11IXTUI111
PRY REQUIRED
YES 0 NO 0
ADDRESS
REMARKS
NERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
CITY
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NAME
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ENGINEERING REVIEWEDIDATE
ADDRESS
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FIRE REVIEWED By DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION, 160 DAYS
PERMIT LIMIT. I YEAR - PROVIDED ORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, A SIGNSANDSUCCESORS
IN NTEREST, AGREES TO I DEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. It S OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAND
ALL CLAIMS FOR OA AGES OF WHATEVER NATURE� ARISING DIRECTLY OR INDIRECTLY
FIT M THE ISSUANCE OF THIS PERM" ISEU NOE OF THIS PERMIT SH— NOT BE
EMEO TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI YONDINAPCE
Mon LIMI r INANYWAYTHE CITY S AS, LITYTO ENFORCE ANY.RDINANCE PROV'SIO1
ED
REMA KS L�
PROGRESS INSPECTIONS PERUBC 10aIFINALINtiFhUI:VN MCM M I
10 4-
VALUATION
FEE
PLAN CHECK FEE
BUILDING
PLUMBING
M CHANICAL
IS ADINGIFILL
SURCHARGE
ENG. REVIEW FEES
ENG, INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSH
TOTAL AMOUNT DUE
RE �E$PT
IHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AGENT OF
APPLICATION APPROVAL
GIVEN'y co REcT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED
RGU
WITH CITY AND STATE AIS LATINS CONSIRLIC
IS R L
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TO COMPLY
THE I AGREE , WILL GE F.
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TION. AND IN DOING THE WORK AUTHORIZED THEREDI, N EPSON PLOYED
RELATING TO
FOR INSPECTION
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IN VI CODE OF THE STATE Or WASHINGTON
OF
DATE
WoPIOLATION
KMEN S CoM��RAN CE AND RCW 18SI.
(425)
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SIGNATURE (OWN 0
771 -OM
'RELE�SEDBY DATE
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 YSLILOW INSPECTOR
ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED� UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Fooling ....................
Wall..........................
Pier/Porch .................
Retainlrig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING .. ........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ............
Floor Insulation
Wall Insulation ...........
Ceiling insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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ADDRESS 1�120 kv
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PRV EQUIRED
YES 0 NO 0
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REMARKS
RESPONSIBLE FOR EROSION CONTACILIDRAINAGE
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ENGINEERING REVIEWEDIDATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PR PERTY ONLY. ANY CONSTRUCTION ON THE PUSLK` INGIFILL
0 1 1 GRA
DOMAIN (CURB$. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REDO
SEPARATE PERMISSION. =ORCHARDS
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J_. BE=.. DAYF -�Xe#�MWATES
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLI ANT. ON BEHALF OF HIS OR HER SFOUSE� HEIRS, ASSIGNS AND SUCCESORS ENG. INSPECTION FEE
IN SFEND AND HOLD HARMLESS THE CITY OF LANDSCAPING
PINTEREST, AGREES TO INDEMNIFY. D
M EDMONDS, WASHINGTON� ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECI LY —'
THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
RECEIPT
F
0 EMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANYCITY ORDINANC
I I
1
0 NOR LIMIT IN ANY WAYTHE CITY'SABILITYTO ENFORCE ANYORDINAN
TOTAL AMOUNT DUE RECEIPT
o-,
a
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
-APPLICATION APP�OV
,IVEN RRECT; A THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
C
THE OWNER , I AGREE AVIS REGULATING CONSTPUC.
ISCO NTO COMPLY WITH CITY AND STATE L
CALL
This aPP ..j sh I. hst . p-h uhlil .1gh.,J by Ih.
0, hh,,Y, D,,Ujy:.�l F.bs ps,1, d
Buildmo Offi-i-I I
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
THE Sop C&DANOF THE TATE OF WASHINGTON RELATING TO
FOR INSPECTION
...1p, h, FP.- Pl0VkKd
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IN TOCATION OF
KMEN'S COM N R CEANOACW18.27.
WOIT PENS140
lij
kLS SIqN DATE
OFF GME,
--p (OW.p
SIGNATU E
(425)
771-022 0
RE LEASED By
EXT 333
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
E TO
I FILE YELL ow.,,,pC
Y�
A
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX
NX COLD ASN
PINK OWN..
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