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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
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5 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS . MARQUEES. ETC.) WILL REQUIRE
:1 SEPARATE PER�ISSION.
E SU HA GE
PERMIT APPLICATION:,S'80 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK STARTED 'WITHIN 180 DAYS
NO REV� FEES
SEE BACK OF PINK PERMIT FOR MORE iNFOR A7iON
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECTION FEE
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READ THIS APPLICATION . THAT THE INFORMATION
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APPROVAL
1 HEREBY ACKNOWLEDGE THAT I HAVE
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771-0220
RELEASEDBY DITE
EXT 1333
ATTENTION
ITISUNL FULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
AW
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILER YELLO
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S..
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
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wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
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Equipment
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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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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THEPU BUC
GRADING/FILL
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SEPARATE PEFIZSSION.
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PERMIT APPUCATI N: 111D..S
PERMIT LIMIT'. 1 YEAR - PROVIDED WORK 15 STARTED WITHIN 100 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICAN HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
T. ON FO
e,
1� IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD ARMLESS THE CITY OF
LANDSCAPING
S. EMPLOYEES. AND AGENTS FRO. ANYAND
EDMONDS, WASHINGTON, ITSOFFICIAL ECTLY
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
RECEIPT
x FROM THE SUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
15
PLAIN CHECK DEPOSIT
IF
DEEMEOTO MODIFY. WAIVE OR REDUCE ANY REQU REMENT OF ANY CITY ORDINANC I!
E CEAN Y ORDINANCE PROVISION.
NFOR
A CY
0 NOR LIMIT IN ANYWAY THE CITY'S ABLITYTO
TOTAL AMOUNT DUE
IHEREBY ACKNOWLEDGE THATI HAVE READTHIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I A THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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AND STATE LAWS REGULATING CONSTRUC
CA ILL.
I, het a rehl ,t,l,iglod by the
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HE NER. I AGREE TO COMPLY WITH CITY
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THEREBY. No PERSON WILL BE EMPLOYED
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d'ho tebe, oputy.:,d
TION: AND IN DOING THE WORK AUTHORIZED
CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKME S Pi SATION INSURANCE AND FICW 18.27.
OFFICIALS SIGNA�UAE DATE
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(425)
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771-0220
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EXT 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 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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