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USE PERMIT
CITY OF EDMONDS ZONE NUMBER 711m,999
CONSTRUCTION PERMIT APqPLICATION JOB SUITEIAPT.
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PLAT NAMEISIUSDIVISION NO. I LOT NO,
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTIiUCTION ON THE PUBLIC
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STATE SURCHARGE
MITAPPLtCATI N: 10DAIS
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ENG. REVIEW FEES
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ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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FRO THE ISSUANCE OF THIS PERM" ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE AN REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
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I HIRESI ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT TIE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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APPLICATION APPROVAL
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THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
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CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER COLD - ASSESSOR
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FOUNDATION:
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Wall..........................
Pier/Porch .................
RetalnIng Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
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Gas Test ....................
Gas Piping .................
Equipment .................
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E XTERIOR SHEATHING
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FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
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GE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
OMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PE MIT APPLICATI N: 180 DAYS
PERMIT LIMIT. 1 YEARRPROVIDED WORK IS STARTED WITHIN 180DAYS
SEE BACK Oi PINK PERMIT FOR MORE INFORMATION
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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ALLCI-MMSFORDAMAGESOF H
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IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION �!'P I ATI�NAPPROVAL
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WORKMEN'S CO�MSATION �s RA�CE AND RCW 18.27. OFFICIALS SIGNATURE DATE
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771-0220 ELEASED BY DATE
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