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STATE LICENSE NUMBER
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IVESIED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. TRIB PERMIT C.V IRS WORK TO
BE GONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
A. '.U.... SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
PERMISSION.
P RMIT APPLICATION: 180 DAYS
PERI
RE
PERMIT LIMIT'. I YEA - PROVIDED WORK IS STARTED WITHIN 180 DAYS
PERMIT LIMIT ' YEAR _
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SEE BACK OF I
FSEPARATE
F HI OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
APPLICANT ON BEHALF OF
ON BEHALF o
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�AFPLICANt
N INTEREST AGREES TO NDSMNIFY. DEFEND AND HOLD HARMLESS THE CITY 0;
N NTEREST. AGREES TO
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EDMONDS. WASHINGTON, ITS 0 FICIALS. EMPI OYEES. AND AGENTS FROM A -AND
ALLCLAIIAS FOR DAMAGES OF WHATEVER NATUI.:, ARISING DIRECTLY OR INDIRECTLY
,.S . MA. So
L ' E
OM THE ISSUANCE OF THIS PERMIT ISS �ANI;E 01 THIS PERMIT SHALL NOT BE
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G E ED TO . 'Y W IV E ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMEDT DFY, WAIVE OR REDUC I o
0 NOR LIMIT oi MODI Ty TO ENFORCE ANY ORDINANCE PROVISION.-
N ANY WAY THE CITY S ABILI
A FORMATION
I HEREBY ACKNOWLEDGE TH H E READ THIS APPLICATION. THT THE IN
AT: A'
.. Z T OF
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
RUC
AND STATE LAWS REGULATING CON STRUC
THEOVINER IAGREETOCo.PLY WITH CITY LA
THE . NO PERSON WILL BE EMPLOY ED
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IN VIQLATION OF THE LABOR CODE OF THE STATE OF WASHiNGTON RELATING TO
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W KME�t�EN ATIG 11 SURANCE AND RCW 18 27,
DATE SIGNED
EE PERMIT
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LOWED PROPOSED FRONT SIDE REAR FRONT UPSIDE FEAR
PARKING �7 AREA I PLANNING REVIi*O By- - DATE
:0.0 1 PROVIDED I
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WARKS
ROrRESS INSPECTIONS PER UBC 1081IFINAL INSPECTION
VALUATION I FEE
PLAN CHECK. FEE
BUILDING
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MECHANICAL
GRADINGIFILL
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
T TAL AMOUNT DUE j.
APPLICATION APPROVAL
TN. . P. _1 11 -19- t)l -
CALL
E..uq F... .1. 1-
FOR INSPECTIO14
cF"�ftlTla
(425)
771-0220
IAELEASED BY
11")
TION ' / I EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL qLE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD ASSESSOR
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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:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FL6611 FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .......... ...
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STATE LICENSE NUMBER EXPIRATW
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NOV, PLUMBINGI.ECH A
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HEAT SOURCE LAZING %
LOT
PLAN CHIECK_NOB—a
IIESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THISjlR.—RC RCK To
BE DONE ON PRIVATE PROPER ONLY, ANY CONSTRt CITO. ON THE P
'L FIAE
E"TC.) Wa3l
DOMAIN (CURDS. SIDEWALKS. DRIVEWAYS. MARQUEES;
SEPARATE PERMISSION.
PC MITAPPLICATI N IlODAYS
RPROVIDED
WOOK:I WITHIN ISO DAYS
PERMIT UNIT.. I Y CAR ' R S STA TED
SEC SAC K OF PINK PERMIT FOR MORE INFO RMATION
'APPLICAW, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOW HARMLESS THE CITY OF
2 EDMONDS, WASHINGTOH. TSOFFICIALS. EMPLOYEES. AND AGENTS FROM -ANY AND
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ALLCLAIMS FOR DAMAGESOFWHATEVER NATURE,ARISIN RECTLYORINDIRECTLY
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PEIMIT SMALL HOT 11
0 DEEMEDTO MODII,.WAIVE OR REDUCE ANY ANY CITY ORDINANCE
No. LIMIT IN ANY WAYTHE CITY'S ABILITY To RJC& ANY ORDINANCE PROVISION.
!EIPIMENTOF
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLJC,��T ON. THAT THE INFORMATION
GIVEN S CORRECT, AND THAT AMTHE OWNER. OR TH LILY AUTIORIZ.11 AGETNRTLOF
JAG C. CO'S C
THEOWNER. RIC TO COMPLY WITH CITY AND STATE LAWS R ULATI TR�UC;
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. No PERSON WILL BE EMPLI
�N AOLATION OF THE LABOR CODE OF THE STAT E OF WASHINGTON RELATING TO
WOR ME��ENS to 11 SURANCE AND RCWIS.27.
TUR
PERMITEX IREq
E ERMIT
HE gd� PUMBER
B SUITVAPTI
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_ATNAME/SUBDIVISK)NpO LOT NO. LI N
LID FEE S
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METING PROPOSED�'
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EMARKS
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1INEERING lki liT- 11.
[E REVIEWED By
DATE
VARIANCE OR CU
SHORELI N C OR ADO#
INSPECTION,
REG 'D
BOND
POE ED
OYES 0 No
SERA REVIEW
SIGN AREA
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EXEMPT
ALLOWED PROPOSED
ALLOWED OPO 0
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LOTCOVERAGE
REQU,RFn SETBACKS (Fr.)
PROPOSED ClIsj#t)
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REVIEWED BY
Fp— DATE
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. �ANNING
1.
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;ECIAL MSPECTOI
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PLAN CHECK FEE
BUILDING
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URCFI.ARGE
END REVIEWFO�,_.
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
R
PLAN CHECK DEPOSIT 1
TOTAL AMOUNT DUE IR
CALL
FOR INSPECTION
(425)
771-0220
�"'Wffl!N_TION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
UBC
VALUATION
, ?0 1 4;�T —
kPPLICATION APPROVAL
isn.1 . p.—I �nlll.lglld by the
o,,,,I d, hre,n,, Dty: and Fees are brad. and
W't ...kn111,dQ,d in 6P.—
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ME, �IDATE
ORIGINAL -FILE - YELLOW -INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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