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CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUC.TIONON THE PUBLIC
DOMAIN ICURBS. SIDEWALKS. DRIVEWAYS. MARQUEES ETC. WILLR QUIRE
SEPARATE PERMISSION.
P RMITAPPLICATI N: 180-AYS
GRADINGIFILL
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PERMIT LIMIT. I YEAR - ROVIDED WORK IS STARTED WITHIN 180 DAYS
P
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END REVIEW FEES
PLICANT. ON BEHALF OF HI OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESCAS
-AP S
IN NTEREST. AGREES TO INDEMNIF'Y. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANIAND
ALL CLjUMS FOR DAMAGESOF WHATEVER NATUAE.ARISING IRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
=1 DEEMEDTO MODIFY. WAIVE 0. REDUCE ANY REQUIREMENTOF ANY CIT ORDINANCE
0 NOR LIMIT INANYWAYT.E CITY SABILITY To ENFORCE ANY ORDINANCE PROVISION I
ENG. INSPECTION FEE
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TOTAL AMOUNT DUE
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1 HEREBY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONST.UC-
TION AND I DOING TH E WORK AUTHORIZED TH ERE BY. NO PE RLSON WILL BE E M PLOYED
V'G�AT� 0, HE LA'OR$bINOF THE STATE OF ASHINGTON RELATING TO
WOA A E� C�M'j RA C E AND RCW 18,27,
APPLICATION APPROVAL
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DAT SIGNED
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771-0220
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EXT 1333
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ITISUNL FULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL ILE YELOW INVECTOR
CATE _ OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
or
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RECEIVED
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DEVELOPMENT SERVICES CTR.
CITY OF EDMONDS
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...........
FOUNDATION:
Footing ......................
wall..................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
J- Underground .............
Rough.ln ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
00,
FRAMING .................... ...
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
4-oz_
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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SIGN AREA
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FRONT S.IDE�;R
COMPLIA CEOR
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CHANGE OF USE
PARKING LOT AREA
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PLAN CHECK NO:
IVESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0.
11 Go", ON P111 PROPERTY 0.11. ANY CO.STRUCTIO. ON THE PUBLIC
GRADING/ ILL
L REQUIRE
DOMAIN (CURDS, SIDEWALKS. DRIVEWAYS. MARQUEES. ETC) WILL REQUIRE
SEPARATE PERMISSION.
E 'V FU
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ST
PEAMITAPPUCATI N; IBODAVS
PERMIT LIMIl I 'EAR - PROVIDED WORK IS STARTED WITHIN 130 DAYS
s
ENG. REVIEW FEES
ING Rv' L
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION FEE
a, PLICANT, ON BEHAL OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
'AP
I IN INTEREST, AGREES TO:NDEMNU�.OEFE NO AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. TSOFFICIALS. E-'_YE.S� A.DA.E.IBlA.. ANI.N.
CLAI.SFO..—.ES.FWHATEVE. NATURE, ARISING DIRECTLYOR INDIRECTLY
REC'
RECI
1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
Q DEEMED MODIFY.WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
To
'
0 NOR LIMITIN ANYWAYTHC CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
REC
TOTAL OUNT DUE
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION. THAT THE INFO AM TION
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING COh[STRUC-
CALL
TIOMAND THE WORK AUTHORIZED THEREBY. NO PE AS2 W' ILL BE EMPLOYED
OF WASHINGTON RELAT, NG TO
FOR INSPECTION
0 S
TI OF THE So. CODE OF THE STATE
IN VZo��
MRANCE AND ACW 18 27.
WOR�yll COMPENSATIO�j
_[D�SIONID
(425)
SIG (OWNE ORA kf)
a f
771-0220
1 0
T I
EXT 1333
A17E0(hW
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
HAS BEEN MADE AND APPROVAL 08 A CERTIFI-
771-0221
A FINAL INSPECTION
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
"B
VALUATION I FEE
APPLICATION APPROVAL
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