20000923.pdf'I DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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SEPARATE PERMISSION.
STATE SURCHARGE
PE MIT APPLICATION: 180 DAYS
PERMIT LIMIM 1 AR -PROVIDED WORK IS STARTED WITHIN 180DAYS
YE
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENO. INSPECTION FEE
IN INTEREST, AGREES TO :NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDON,%VFloASHINGAT.0N TF�GFI EMPLOYEES, AND AGENTS FROM AN' AND
ALI _ CLAIM ADAM E�G ATEVER NATUAE,ARiSINGDIRE_
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 6
PLAN CHECK DEPOSIT
RECEIPT
T MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
DEEMED 0
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIStO
TOTAL AMOUNT DUE
REG mo 1-4,
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
A7,131_1�A�!�N APPROVAL
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CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON
CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIONJ aFeI,dg,d,. pace P1.1c.d.
IN VIOLATION Or THE LABOR
WORKMEN'S COMPIENSrATJP�N"'URANCE AND AGIN 18.27.
DATE
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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
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR
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 ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
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DATE RECEIVED
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CITY OF EDMONDS
ZONE NUMBER
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ADDRESS
CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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PROGRE.SINSPECTIONS PER UBC 1081FINAL INSPECTION RECOICI
VALUATION
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CBEA URGE GLAZING % LOT SLOPE %
g� I I
BUILDING
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PLAN CHECK NO: IVE6TED DATE
PLUMBING
MECHANICAL
CXD
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING/FILL
00 MAIN (CURBS. SIDEWALKS, DRIVEWAYS , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
IsERMITAPPLICATI N: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. INSPECTION FEE
�APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCE SOPS
0
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY F
C
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AN AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR IND RICTLY
REL""
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT 1"ALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REGUIREMENTOF ANY CITY ORDINANCE
PLAIN CHECK DEPOSIT
I
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
E
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPL CATION; THAT THE INFORMATION
APP ICATION APPROVAL
GIVEN S CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
This sppll�liml is 'It I P11111 11111119111 by this
T E OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
30,1119 0111.11111 hllnill Enipuly: and Flo, 11, plid. Ild
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIO
0 P
IN recaipt is ackn—locig d in P.vid.d.
WORKMEN COMPENSATION NSURANCE AND RCW 18.27.
OFFICIALS SIGNA�URE DATE
(OWNEPR AGENT) _7E SIGNED
(425)
1,9116NATURE
771
-0220
J�L�A�E. BY DATE
ATTENTION
EXT/333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL IN SPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORiGINAL-FILE YELL.W-INSIECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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