20010533.pdfI)ATC RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ITY ZIP ITE111HONE
NAME
ADDRESS
CITY ZIP TELEPHONE
ROPERTY TAX ACCOUNT
PARCEL NO.
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0 NEW
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0 PLUMBINGIMECH
0 AUDITION
0 COMMERCIAL
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CHANGE OF USE
0 REMODEL
0 APARTMENT
0 SIGN
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0 IRAIIII CYDS
0 F "IS
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0 DEMOLISH
0 TANK
o GARAGE
CARPORT
r-I RETAINRING WALL
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0 RENEWAL
(TYPEOF USE. BUSLNESSORACTIVIT 6m
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REMARKS
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PROGRESS INSPECTIONS PER LISC 1081FINAL INSPECTION REOlD
VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE GLAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO: f
6QEETED DATE
PLUMBING
MICI-IANICAL
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
H P
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T E USLIC
GRADINGIFILL
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DOMAIN (CURBS. SIDEWALKS, DRIVEWAY , MARQUEES, ETC.) WILL RED IRE
SEPARATE PERMISSION.
P RMIT APPLICATION: 10 DAYS
'ERM
STATE SURCHA GE
P WO
PERMIT LIMIT. I YEAR ' ROVIDED RK IS STARTED WITHIN 100 DAYS
R I I I YEAR - P
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C C K OF P
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
P
END INSPECTION FEE
S GRE E I DEFEND AND HOLD HARMLESS THE CITY OF
IN INTEREST, AGREES TO
LANDSCAPING
INDEMNIFY.
2 EDMONDS WASHINGTON� ITS OFFICIALS. EMPLOYEES. AND AGENTS FRO. ANY AND
S WAS
INSPECTION FEE
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
IF LA
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
IS
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0 EMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAN C
E E.E. To .0 1 Y . W �V 0
PLAN CHECK DEPOSIT
OR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
OR LIMIT IN Y . Y THE I,
N AN A
CIE 15
TOTAL AMOUNT DUE
!1
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION,APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER JAGREETOCOMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
T I 1ppl,111,1- P. ..I -11.1pld by th,
TION. AND IN DOING 'HEWORKAUT. RIZED THEREBY. NO PERSON WILL BE EMPLOYED
B..'.1 , g._' D,p.ty: .,d F ... ... pAd.
IN VIOLATION OF THE LABOR CODEOOF THE STATE OF WASHINGTON RE LATING TO
FOR INSPECTION
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WORKMEN S COMPENSATION INSURANCE ANP RCW 1 B 27
OFF LIFE
DATE SIGNED
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RELEASEg DATE
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A FINAL INSPE A BEE ADE AND APPROVAL OR A ER IFI
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ORIGINAL - FILE YELLOW INSPECTOR
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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 ..................
j
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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REMARKS
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STATE LICENSE NUMBER
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002 C0
0 NEW
JR RESIDENTIAL
0 LUMBING/MCCH
0 ADDITION
0 COMMERCIAL
o OMPLIA EOR
CHANGSOFUSE
0 REMODEL
C3 APARTMENT
0 SIGN
43"REPAIR
0 GRADING CYDS
F INCE
0 ( _x _FT)
0 DEMOLISH
0 TANK
'R O>*ke' v--
oGARAGE
CARPORT
0 RETAINING WALL
ROCKERY
0 RENEWAL
ITYPE OF USE. BUSINESS OR ACTIllT'5M
NUMBER
NUMBER OF
CRITICAL
AREAS
OF RIES
STO
DWELLING
UN TS
NUMBER DO-R/L
DESCRIBE WORK TO BE DONE
FIRE REVIEWED By
DATE
I POSTED
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FEaD I PROVIDED r LOT AREA
CHECKED By
YES
=RKS
—" lNqPFrTIONS PER UBC 1081FINAL INSPECTION REO'Di
VALUATION
FEE
PLAIN CHECK FEE
HEAT SOURCE LOT SLOPE I
BUILDING
JESTED DATE
PLAN CHECK NE��
PLUMBING
MECHANICAL
THIS PERMIT ALITH.'"""S ."T." W. RK --T�.. THIS PER." COVERS WORK TO
L' CONST."CT.. ON THE PUBLIC
BE G..E ON PRIVATE PROPER ' -N . AN'
GRADINGIFILL
DOMAIN 'DUF.S.SIDEWALKr.`GR"EW�"S' AF..EES' ETC, W'LLREQUIRE
SEPARATE PER.ISS'.N'
STATE SURCHARGE
PERMIT APPLICATION: I00 DAYS
PERMIT LIMIT.- 1 Y , PROVIDED W RK IS STARTED W ITHIN 161) DAYS
EAR 0
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'AP LICANT. ON BEHALF 01 HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTI N FEE
IN IpNTE EST, AGREES TO INDEMNIFY. DEFEND AND H.L. HARMLESS THE CITY OF
LANDSCAP NO
EOMONR ANYAND
DS,WASHIMGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM
INSPECTION FEE
L LAIMS FOR DAWCESOF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
AL C NOT BE
FROM THEASSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERIMIT SHALL
9 DEEMED TOMODIFY. WAIVE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
PLAIN CHECK DEPOSIT
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINA CEPROVIS10N.
...
TOTAL AMOUNT DUE
RE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN 15 CORRECT. ANDTHAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENTOF
FF111-1— 11 . p.—I u�lll Ip.d b, 11.
THEOWNER. IAGREE TOCOMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Bu,_q 0,,,_. ., gp.ly� -d F— — pvd� ..d
G
7ION, AND IN DOING THE WORK AUTHORIZED THE REBY, NO PER SON WILL BE LEM PLOY ED
OF WASHINGTON RE ATING TO
FOR INSPECTION
.—I. I gad in spaw provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN I C2!jP4NSATION INSURANCE AND ACW 18 27
OF URE
E KIN
(425),
B_>LE116R�AGEIT
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RELEASE D E
"��MENTYON
X 133
T 133
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Up
ITtSUNLAWFULTOUSEOROC P A BUILDING OR STRUCTURE U TiL 771-0221
6 j
kADE
A FINAL INSPECTI I.. AS SEE AND APPROVAL OR A CEUR IFII
-
ORIGINAL -FILE YELLOW - INSPECTOR IF
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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