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PERMIT APPLICATION 180-AYS
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PERMIT LIMIT: I YEAR - PROVIDED IN RK IS STARTED WITHIN 180 DAYS
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TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT,AND THAT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
AND STATE LAWS REGULATING CONSTRUC-
CALL
THEOWNER, IAGREETOC MPLY WITH CITY
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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FOR INSPECTII
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING
WOHK�[J'S COMPENSATION INSURANCE AND ROW 18.21,
DATE
(425)
WUWA
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EXT 333
ATTEI,trYON
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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GRANT FINAL PROJECT APPROVAL
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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SETBACKS .....................
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Pier/Porch .................
RetainirigWall ...........
Stab Insulation
PLUMBING:
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HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING .......................
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FRAMING ........................
FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
Wall Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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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
GRADINGIFILL
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REOUIRE
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SEPARATE PERMISSION.
STATE SURCHARGE
PE MITAPPLICATION; ISODAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS�STARTEO WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A
ENC
PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPIN
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
INSPECTION FEE
ALLCILAIMS FOR DAMAGE OFW14ATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
I FROM THE ISSUANCE 11 THIS I'll" ISSUANCE 11 THI PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY�S ABILITY TO ENFORCE ANY OROINANCE PROVISION,'
TOTAL AMOUNT DUE
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IHERE Y ACKNOWLEDGE THAT I HAVE READ THIiAPPLICATION� tH
,*HE I.N.IORMATI N
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APPLICATION,APPROVAL
GIVEN
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WORKM ION INSURANCE AND ;. 18,21,
IFI'S COMPENS�T
DATE
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SIG? �7(;
(425)
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RELEASED BY IIATE
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EXT 333
IT IS UNLAWFUL TO USE OFf'6CDUPY A BUILDING 08 S�RU TUREUNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR,A,,GERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. uBc s5pTION 1
FAX
ORIGINAL -FILE YELLOW 'INSPECTOR
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