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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE 107 PERMIT
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PILAT NAMEiSUBDIVISION NO IOTNO. LID NO,
11. FEE S
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK 10
PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
51 GOEDONEON
MAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
.
STATE SURCHARGE
MIT APPLICATION: ISO DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK'S STARTED WITHIN I SO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO REVIEW FEES
ENG, INSPECTION FEE
ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IPER
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H E READ THIS APPLICATION. THAT THE INFORMATION
I HEREBY ACKNOWLEDGE THAT AV
APPL CATION APPROVAL
GIVEN IS CORRECT, AND THAT A. THE OWNER. OR THE DULY AUTHORIZED AGENT 01
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TION AND IN DOING THE W08K AUTHORIZED THEREBY. NO PERSON
CODE THE STATE OF WASHINGTON RELATING TO
OR INSPECTION
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WORKMEN S PENT� ON INSURANCE AND RCW 1827
11 IALS SIGNA:��Dr�j
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SIGNATURE
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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 CERI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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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 FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR JL,_6
OCCUPANCY ..................
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SIGN AREA
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THIS PLF MIT AUTHQIIIZC� ONLY THE WORK NOTEII. !HIS PER1,07 COVERS YtOr.,� TO
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. BED ON PIIWXiE PROPERTY ONLY. ANY CONSTRUCTION ON THE
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2 WAYS' MAROUEES, ETC.) WILL R QUIRE
DOMAIN (CURDS. SIDEWALKS. DRIVE
MISSIo
SEPARATE PER N
_ATF "IR,.AR.E
PIRMITAPPLICATIO ; I60OAYS
PERMIT LIMIT. I YEAR, ROVIDED WORK 15 STARTED WITHIN 180OAYS
P
FE ES
END. REVIEW FEES
END
SEEBACKOF PINK PERMIT FOR MORE INFORMATION
END N E. T . FEE
0. BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT.
N NTEREST. AGREES TO :NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
A p IN G
LANDSCAPING
LAND Sc
EDMONDS, WASHINGTON, TS OFFICIALS. EMPLOYEES, AMD ACE NITS FROM ANY AND
ALLCLAIMSFORDAMAGESaFWHATEVER NATURE.ARISINr GIRECTLYOR INDIRECTLY
CT'-W
IN. F E N EE
RECEIPT
.EC IPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS F EAMIT SHALL NOT BE
PLAN CHECK DEPOSIT
A , K GE .SIT
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PL N C. C
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITYORDINANC E
NOR LIMIT IN ANY WAY THE CITY S A81LITY TO ENFORCE ANY CADMAN— P-1.10N.
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TOTAL AMOUNT DUE
jR7CEr a
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMAT ON
_f
APPLICATION
APPROVAL
GIVEN 15 CORRECT. AND THAT I AM THE OWNER. 0. THE DULY AUTHORIZED AGENT OF
Th., ppjj,l hI lot A RII.t IIIII lignad by the
THE OWNER I AGREE ToCOMPLIWITHCIT AND STATE LANS REGULATING CONSTRUC-
L
CALL
B1.1,11.9 0"11-1111 h81 olp,t, 1hd F681 11, p1hi, Ild
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION 2H ABDR CODE OF THE STATE OF WASHINGTON RELATING 0
. P CT", d
FOR INSPECTION "k--ged , spiom prowuja
KMEN S oNINSURANCE AND RCW 182T
wop S GA.F E N�
OFFIJIALS SIGNATUR
(425)
(425)
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SIGNATURE j�
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�69403
771-0220
RE - MATIE
ATTENf"
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD - ASSESSOR
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