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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
USE ERMIT
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NUMBER
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO,
FEE S
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0 SIGN
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0 REPAIR Ei GRADING CYDS cl (FENCE X FT)
REMARKS
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NUMBER NUMBER OF CRITICAL
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REMARKS
^F�q IIMRPrrTI0NS PER UBC 1081FINAL INSPECTION REG
INSTAU_ 0-x� 50M8.
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HEAT SOURCE GLAZING I
LOT SLOPE I
PLAN CHECK NO:
IVESTED OAT'
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK 10
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DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THEP B
DIE RE
OMAIN (CURBS. SIDEWALKS. RiVEWAYS, MARQUEES. ETC.) WILL QUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR. PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORM ION
ON BEHALP OF HI OR HER S OUSE, HEIRS. AllIGNS AND SUCCESO S
S P
;APPLICANT,
N NTEREST. AGREES 0 EMNIFY. DEFEND AND HOLD HARMLESS THE CITY 1
IND
2 EDMONDS4WASHINGT.N ITS OFFICIALS� EMPLOYEES. AND AGENTS FROM ANY AN
ALLCI_MMSFOR ANIAGE� OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
BE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT
DEEME 0 To "ODI FY WAIVE, OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
E IROI ISION.'
'SABILITYT
0 NOR LIMIT IN ANY WAY THE CITY 0 EN FORC E ANY ORDINANC
I R EREBY ACKNOWLE DOE THAT I HAVE READ THIS APPLICATION: THAT TH E IN FORMATION
GIVEN Is RRECT AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
CO ;
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THCOW�ER I AGREE TOO MPLY WITH CITY AND STATE LAWS REGULATING CONST U
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TION, AND IN THE WORK AUTHORIZED THEREBY, N PERSONWILLBEF MPLOYED
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WASHINGTON RE ATING TO
IN VIOL kTION OF THE LABOR CODE OF THE STATE OF
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PLAN CHECK FEE
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ENG. REVIEW FEES
END. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
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IALS TURE DATE
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771-0220
WE6 BY- D E
'ATTENTION rm A 1 .3 0.2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221 YELLOW INSPEC70R
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
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Underground .............
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Gas Test
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FI.6m FRAMING
JNSULATION o .................
Floor Insulation
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Wall insulation ............. ---------
Coiling Insulation
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SHEETROCK NAILING
IT
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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PERMIT EXP�IRES��
USE
PERMIT p,
CITY OF EDMONDS
ZONE
NUMBER
CONSTRUCTION PERF#lt APPLICATION
'A%URESS
SUITE/AFT'
OWNER NAME NAME 01 BUSINESS
FLAT NAME)SUBDIVISION NOI
LOT NO.
LID NO.
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I
LID FEE S
MAILI NO ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
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CITY ZIP
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METER SIZE
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NO. OF FIXTURES
PRV REQUIR
NAME
YES CJ NO
REMARKS Al E
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTR UOR NA
se
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TELEPHONE
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STATE —LICENI� NUMBER E�PIPAII.N C
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ADDITION
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CHANCE OF USE
R_-ODEL
REMO DEL
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APAR
SIGN
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CGAFIAGE
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C] RENEWAL
CARPORT
OF SE�. BUSINESS
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OR ACT�IVIT'rl EXPI.AIN'
L7
R(TYPEE
NUMBER
NUMBER OF
C lTiCAL
.F1T'CA
OF
STORIES
DWELLING
NIREAS
A
NUMBER
DESCRIBE WORK TO
BE DONE
FIRE REVIEWED By
DATE
DY�;_6N. I __ __
HEK3HT
SERA REVIEW SIGN AREA
COMPLETE I EXEMPT ALLOWED , PF.IOSEO ALLOWED I PROPOSED
ixp VERAG _ OUIRED SETBACKS (FT.) PROPOSED SMACKS (Fr.)
LOT CO E RE REAR
ALLOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE
E ,;UG L�7��ED BY DATE
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CHECKED BY TYP OF CONST U TION coo ICIIPAN,�,
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KNOWLEDGE
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BUILDING
PLUMBING
PLAN CHECK NO:
MECHANICAL
�PEAMIT
__71S AUTHOR ZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
M DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
WA'
DOMAIN (CURBS, SIDEWALKS,
DOMAIN 'CUR " 'SIDE SEPARATE PERMISSION.
L
GRADINGIFILL
RCHARG
so PERMIT APPLICATION! 180 DAYS
PERMIT LIMIT'. I YEAA. PROVIDED WORK IS STARTED WI HIN 180 DAYS
I T
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
L SUSCAPING
IN PECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESDAS
1_ IN I.N�TE�REST.AAGRE.ETSDN` NU"MN,FY, DEFEND AND HOLD HARMLESS THE CITY OF
ED U. ' AS To 'T� CIAES, EMPLOYEES. AND AGENTS FROM ANYAND
U.,W SHIN . :T OF
.N W HIN N�o
LLCLAI�'=R�DAM�AGI,,To.,,�WHATEV �NAT���,A�l�lN��l�E(�TIY.1,N��RECILY
A C M . M E
THE NO
0 0- FROM THE ISSUANCE UP T.' RERMIT. ISSUANCE OF THIS PERMIT SHALL NOT B
� OEEMED TO MODIFY. WAIVE OR C I REMENT OF ANY CITY ORDI NANCE
'0 oNOR LIMIT IN ANY WAY THE CITY. EDUCE ANY RE U
0 R LIMIT IN ANY WAY THE S ABILITY TO ENFORCE ANYORDINANCE PROIISION.-
RECEIPT
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
N ORMATION
THAT I NAI READ THIS APILICATION� THAT THE I F
APP [CATION
I HEREBY AC
GIVEN IS CORRECT� AND THAT t AM THE OWNER. OR THE DULY AUTHORIZED AGSNI 01 - TIe. PpIlo I.— I, - o Ferrell u,,jil sig— el ll�.
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL 'ui'dimg off,,i,l or histier Deplty: ,d Fees are P.1d. .d
TION ANDINDOINGTHEW RK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED R INSPECTION
IN I LATION OF THE LAB R CODE OF THE STATE OF
K CVS COMPENSATIONeNKRANCE AND POW IB.27
Wp�N
WASHINGTON RELATING TO
rw
(425)
771-0220
OF AT I
,;0F ;CIALSSI. A
L ASED y
IGNAT RE (OWNER EN
EXT 333
NG 08 STRUCTURE UNTIL
IT IS UNLAWFULTO USE OR OCCUPY A BUILDI - 771-0221 ORIGINAL FILE YELLOW -,INS,',,ECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI FAX PINK -OWNER GOLD A BE
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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