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PERMIT
CITY OF EDMONDS NUMBER 2M26n
CONSTRUCTION PERMIT APPLICATION J.a
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PERMIT APPLICATI N: ISO DAYS
T PERMIT LIMIT. I YEAR, PROVID 0 WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT. ON BEHALF 01 HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
INPINTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS HE CITY OF
LANDSCAPING
a EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES. ANDLAGEINTS 1R.. ANY AND
ALL CLAL.1.1,FS01 1AMA11FIT0.1, WHATEVER NATURE. ARISING IRECTLY OR INDIRECTLY
INSPECTION FEE
RECEIPT
FROM T SUAN;E C S PERMIT ISSUANCE OF THIS PERMIT SH ILL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY. WAIVE On REDUCEANY REQUIREMENTOFANY CITYORDINANCE
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NOR LIMIT IN ANYWAY T.ECITY'SA LITYTO ENFORCE ANYORDINANCE PROVISIONjo
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
AliPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER, I AGREE TO COMPLY WITH CIT AND STATE LAWS REGULATING CONSTRUC-
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL B E EMPLOYED
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
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WORKMEN S COMPENSATION INSURANCE AND RCW 18.27,
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wait ........... I ..............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
Rough:ln ...................
commercial Final
HEATING:
Gas Test
GasPiping .................
Equipment ..........
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ...................
FIRST FLOOR FRAMING
INSULATION ...................
Floor insulation
Wall insulation ...........
Coiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR —4,
OCCUPANCY ..................
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CITY OF EDMONDS
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
51
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE ..ZING I LOT SLOPE %
BUILDING
PLAN CHECK NO: _M T IV59TED DATE
N I G
PLUMBING
MECHANICAL
THIS PERMIT AUTHO IZES KILT THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
GRADItkG/FjLL
COMAIN (CURBS, SIDEWALKS. DRIVEWAYS' MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED W17HIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
ENG, INSPECTION FEE
'APPLICANT. ON BEHALFOF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 TON, ITSOFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND.
EDMGN
INSPECTION FEE
1. ALLCI,AIM�FORDAMAGESO WHATEVER NATURE, ARISING DOIECTLYOR INDIRECTLY
RECEIPT
I FROM THE ISSUA CE OF TH , PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORM ANCE
PLANCHECK DEPOSIT
ORDINANCE P `oVS'oN *
0 NOR L MIT IN ANY WAY THE CITY SABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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TOTAL A ... NT ELE
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I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION, THAT THE INFORMATION
APP ICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
:
�Ppl.�t.. - � p,,.,i ni.1 I.g.,d by I,,
HEDWINER, IAGREETOCOMPLYWITHCI Y AND STATE LAWS REGULATING CONSTRUC
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PER50N WILL BE EMPLOYED
CALL,
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Offi-I 11 h-11 DIP.ty; 6ld F*el P. Ild
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IN V161LATION Or THE LABOR CODE OF THE STATE OF WASHINGTON RE LATING TO
FOR INSPECTION
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WORKMEN S COMPENSATION INSURANCE ANDRCW 1827.
DATE NED
si A, S
uR= GEN
(425)
1
RELEAS�
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EXT 1333
rrN
'A
T LAVv,U L TO USE'OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-042 1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
LOW -INSPECTOR X
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER G�OLLD - ASSESSOR
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