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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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FIRE REVIEWED By DATE
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INSPECTI �NIIN
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POS TEE
STATE LICENSE NUMBER EXPI—ION DATE
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SERA REVIEW
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SIGN AREA
ALLOWED PROPOSED
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ALLOWED �P(35ED
PROPERTY TAX ACCOUNT PARCEL No.
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FRONT URSiDE REAR
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PF NUMBER
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REMARKS
ROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
- A. NOIRE
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AV
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SEPARATE PERMISSION.
tE
STATE SURCHARGE
ST T S.
PERMIT APPILICATIO 1@0 DAYS
P S
PERMIT LIMIT. I YEAR ROVRO'D Won K IS STARTED WITHIN ISODAYS
ENG. REVIEW FEES III
G R 'F
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fe
'APPLlCANT.ONBE.ALFOFHI 09 HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
S
ENG. INSPECTION FEE
M ES
IN INTEREST, AGREES To INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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- E ITS OFFICIALS. EMPLOYEES, A DAGENISFROM ANYAND
'0 �bi. WASHINGTON ' ITS OF RCIALS E M L
OR INDIRECTLY
INSPECTION FEE
INSPECTION FEE
IF
E ARISING DIRECTLY
M IN T EVER NATUR .
A C IME FOR A AGES OF
LL LA 0 IT , BE
SHALL NOT BE
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M ISS C HIS PE EMIT ISSUANCE 0, T., S PERMIT
FRO THE LAN E OF T
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ED GO F At
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I INAN HE A
TOIIALAMOUNTOUE
I HEREBV ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
AGENT OF
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE ULY AUTHORIZED
STATE LAWS REGULATING CEO'NP'TRUC
CALL
LY WITH CITY AND
THEOWNER IAGREETOCOMP M
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE ILOYI
RELAT No TO
FOR INSPECTU
IN VIOLATION OF THE LABOR CODE OF THE STATE .1 WASHINGTON
WORKMEN S COEIPENSATIO RANCE AND RCW 16 27
SIGNATURE (OWNER AGENT)
(425)
771-0220
ATTENT194C
EXI 1333
IT IS UNLAWFICTE 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
518
VALUATION FEE
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APPL14ATION APPROVAL
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Build,19 Otl,,,al 11 hillhll Deputy: ,d Fell 11, plId, Ild
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S SIGNATURE DATE
ORIGI—FILE - YELLOW- INSPECTOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing : ...................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
M
Underground .............
Rough -in ...................
ail
M
Commercial Final
IT1
HEATING:
Gas Test ................ ...
x
M
Gas Piping .................
Equipment .................
Commercial Final
E)ITERIOR SHEATHING
NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING
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INSULATION ...................
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Floor Insulation
Wall Insulation ...........
Coiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMENAME OF BUSINESS
MAILING ADDRESS
CITY 'F ITILE111111
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ADDRES
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER 110NOATE ]A
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0 NEW
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PLUMBING f NECK
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COMPLIANCE OR
CHANGE OF USE
0 REMODEL
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SIGN
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0 F,'NCE
0 DEMOLISH
TANK
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GARAGE
0 Rl.TA.101,NyG WALL
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OF
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UM ER.F
'WELLING
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NITS
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'REAS
A
UMBER
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DESCRIBE WORK TO BE DONE
NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
-PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT. I YIEAR. PROVIDED WORK IS STARTED WITHIN IBD DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 0
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
R DAMAGESOF WHATEVER NATUR
AULCLAIMSFO E. ARISING DIAECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT.'S
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REGUIREMENT OF ANYCITY ORDINAN
^DATE RECEIVED
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USE ' T
ZONE NUMSER C�W
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JOB SUITIVAPTO
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LID FEE I
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METER SIZE
LINE SIZE
LINE SIZE
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I NO, OF FIX URES
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P R V RE
YES 0 No 13
Y S 0 No
EM A S
MARKS
E_ E' OR E 0 CONTPO-E IN A G E
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIGRAINAGE
WN ONTFACTO R RES PON E
rVAR;ANCE
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ENGINEER N
DATE
FIRE REVIEWED BY DATE
OR CU
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IS
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POSTED
SERA REVIEW
COMPLETE EXEMPT
Exp
SIGN AREA
ALLOWED PROPOSED
HUGHT
ALLOWED PROPOSED
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ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UPSIDE REAP
PARKING _T_L_0_T_A_RE_A]
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
VALUAT ON
FEE
PLAN CHECK FEE
BUiLDING
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Pl. MOING
MECHANICAL
0
GRADINGfFILL
STATE SURCHARGE
ENG. REVIEW FEES
ENO. INSPECTION FEE
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INSPECTION FEE
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NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANYORDMANCE PROVSK) I
TOTAL AMOUNT DUE
RECEIP
1,-)s '-50
1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INIORMATK'N
APPLI ATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T
THE OWNER. I AGREE 0 LY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TOC MP
CALL
'.'Idi�hg Offi�i.j ., b,~ D.pWy: And F... A I. Im d, .�d
TION;ANDINDOINGTHEW RKAUTH RIZED THEREBY. NO PERSON WILL BE EMPLOYED
0
WASHINGTON RE LATING TO
FOR INSPECTION
ipl Is,,k,,.t,dgad,n sp- pmided.
IN VIOLATION OF THE LABOR CODE'OF THE STATE OF
WORKMEN'S COMPENSATIg=NCE AND RCW 111.27.
OFF1 LS SIGNATURE DATE
D;7
(425)
11 )
SIGNATURE (OWNER AGENT)
.4 'AlOu
C"00
1;2
_j
771-0220
H ASEO 8
EXT 1333
ATTENT19K. .-
IT IS UNLAVV'FM TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - RILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK. OWNER - GOLD -ASSESSOR
5,98