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CONSTRUCTION PERMIT APPLICATION AD
OWNER NAMEMAME OF BUSINESS
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PLAT NAME/SUBDIVISION
LID FEES
MAILING AO DRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
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NAME
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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(TYPE OF USE. BUSINESS
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DEI OCCUIA
NUMBER
NUMBER OF
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AREAS f
SPECIAL INSP ECTOR L-A'REAu/
OCCUPANTS/•
LOAD
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STORIES
UNITS
NUMBE W
REOUIREp YES
DESCRIBE WORK TO BE DONE ....,......
REMARK'
PROGRESS INSPECTIONS PER USC I08/FINAL INSPECTION REO'
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PLAN CHECK NO: VESTED DATE
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MECHANICAL
THIS PERMIT AUTN• IZE9 ONLVTHE W 07ED. THIS PERMIT COVERS WORK TO
BE DONE ON PR VATE PROPERTY 0 LW7 AK[1V CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURB ,'IDEWA ETC,)WILL REQUIRE
SEPARATE PERMISSION,
STATESURCHARGE •0- / �'/•4(
PERMIT APPLICATION: 18. DAYS
PERMIT LIMIT: 1 YEAR • PROVIDED WORK IS STARTED WITHIN 18U DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF 0,,HIS OR HERSPOUSE, HEI RS,ASSIGNSAND
CITY RS
ENO. INSPECTION FEE
HE OF
IN INTEREST, AGREES TO INDEMNIFY, DEFEND ANO HOLD HARMLESS THE CITY OF
EMPLOYEES. AND AGENTS FROM
LANDSCAPING
INSPECTION FEE
EDMONDS.WASHINGTON, ITSOFFICIALS, INYAND
OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
RECEIPT
ALL CLAIMS FOR DAMAGES
FROM THE ISSUANCE OF THIS PERMLT. ISSUANCE OF THIS PERMIT SHAH NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDU6E ANY REQUIREMENT OF ANYCITY ORDINANCE
TO ENFORCE ANY ORDINANCE PROVISION'
RECE T
NOR LIMITINANYWAY THE CITY'S VILITY
'
TOTAL AMOUNT DUE
_
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT 1 AM THE OWNER, OR THE OULL AUTHORIZED AGENT OF
AND STATE LAWS REGULATING CONS
CALL
Tftis epplicelion is nol a por II unlll e e
T 10^e ylne
THE OWNER. IAGREE TO COMPLY WITH CITY
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
.."d, p Opidel or Rie/Rer O9puly!and Fdee are paid. and
1. In spub .vld.l.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
aceipl ecMnowledg.d
WORKMEN'SCOMSATION INSURANCE AND RCW 18,27.
TURE V D/TE
SIGNATURE RAGENTI DATE SIGNED
NEP
^ C
(425)
ZS ( 1 r
771-0220
RE Y DATE
ATTENTION
EXT 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE.RTIFI-
ORIGINAL. FILE YELLOW INSPECTOR X
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD •ASSESSOR
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RECORD OF INSPECTIONS
I
INSPECTOR DATE APPROVED
Ely
1°
SETBACKS
I
FOUNDATION:
s_
Footing......................
Wall ..........................
-
I
PlerlPorch .................
Retaining Wall ...........
! m {
s
Slab Insulation ..........
PLUMBING:
tJ M
Underground .............
i
M 0
Rough -in ..................
0
Commercial Final
m.�
......
m
CI
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HEATING:
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Gas Test ....................
—_
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Gas Piping .................
-
O 91 I
t
T T
Equipment .................
mm i
r
Commercial Final
EXTERIOR SHEATHING
C) mi
i
NAILING ..........................
N
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FRAMING ........................
FIRST FLOOR FRAMING...''
I 2 ni.
. INSULATION ...................
Floor Insulation .........�
I'
Wall Insulation ...........
-
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Ceiling Insulation .......
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SHEETROCK NAILING
m
SPECIAL INSPECTION
:;r
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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