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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMMA E OF 9 S NESS
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MAILING ADDRESS
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ADDRESS
Fp—ERMIT EXPIRES A�f�Ll
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Pl-AT NAME)SUBDIVISION NO I IOTIO, LID NO,
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP =171: P`N:
EXISTING � PROPOSED—
HEOUIRED DEDICATION— FT
PRV REQUIRED
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FIRE REVIEWED By DATE
CITY ZIP T11.11"Ill
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VARIANCEORCU I p—ORELINEORADS' I INSPECTIW
STATE LICENSE NUMBER
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710
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SERA REVIEW SIGNAREA
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-PROPERTY. I" ACCOUNT PARCEL NO.
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EXP
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0 PLUMBING / MEDIA
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ALLOWED PROPOSED FRONT SIDE REAR FRONT UR
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MECHANICAL
IZES 014 THE RK TED. THIS PERMIT COVERS WORK TO
of
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ON THE PUBLIC
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IVE'AYS ARQUEES. ETC.) WILL REQUIRE
GRADING)FiLL
DOMAIN (CURBS,SIDEW K . . S
BE ATE ER SION.
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
WORK IS STARTED WITHIN 160 DAYS
ENG. REVIEW FEES
PERMIT LIMIT.'I YEAR " PROVIDED
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HCIRS� ASSIGNS AND SUC ESORS
EFEND HARMLESS THE CITY OF
END INSPECTION FEE
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AINEDESOLD
IN INTEREST, AGREETSON) :TNOEM-1,-
'. PLO AND AGENTS FROM AN' A14D
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I EDMONDSjWASH'NG
DAMAGEi OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ALLrIM FOR
Iss F I. S PERMIT SHALL NOT BE
ISSUANCE OF THIS PERMIT UAE�oCiROMENT'
PLAN CHECK DEPOSIT
FROM THE OF ANY CITY ORDIVINANCE
D11MIDTOMODIFY A Y
OR EDUCE ' RNFORCE PRO ISION'
ANY ORDINANCE
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TOTAL AMOUNT DUE
I 1� E Rl.Y ACK H I�S A PP'l I.CAT I ULJ� THAI THE 'NI. MATION
LEDGE THATI HAVE READT,
. AUTHOR IE. AGENT OF
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WITH CITY AN6 STATE LAW
CALL
THEOWNER IAG E TO COMPLY P YE.
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7-0—
(425)
771-0220
EXT 1333
ATTENTION
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 1 09
FAX
198
VALUATION FEE
APPLICATION APPROVAL I
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DATE APPROVED
SETBACKS .....................
FOUNDATI - 0 N.:
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Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insuladon
PLUMBING:
Underground .............
Rough -In ...........
Commercial Final
HEATING:
GasTest ....................
Gas Piping ................
Equipment ............ 0..;.
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR VVV
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THIS PERMIT AUTKO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2 00 MIN (CURBS. SIDEWALKS. DRIVEWAYS. MARO USES, ETC.) WILL REQUIRE
:I ISSION -
epgFtM'
SEPARAL-6
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PERMIT API'LiCATION41100AA
PERMIT LIMIT, 1 YEAR - PROVIDED WORK 1. RTED WITHIN Igo DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. REVIEW FEES
EHG. INSPECTIO� FEE
'APPLICANT. ON BEHALF OF HIS OR H ER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
AR E H F
ML 'S
IN NTEREST, AGREES TO INDEMNIPV. DEFEND AND HOLD HARMLE
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ALL CLAIMS FOR DAMAG ES OF WHATEVER NATURE. ARISING DI RECT, I
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PLAN CHECK DEPOSIT
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DEEMEDT UCEANY PEOUIREMENTOFANYC TYORDINANCE
9 MOD'
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TOT4 AMOUNT DUE
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�.!CEIJS Zj�;?
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
IS CORREC A Z T
GIVEN T. AMD T AT I A. THE OWNER. OR THE DULY AUTHORIZED AGENT OF
TN. I- �.I - P-Mil uM4.ip.d bj 0h.
TAUC
THEOWNER, IAGREETOC MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
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CALL
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TION. AND IN DOING THE WORK AU HORIZED THEREBY. NO PERSON WILL BE
A ATING T
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REL
INSPECTION
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IN VIOLATION OF THE OR CODE OF THE STATE OF WASHINOT N
WORKMEN'S COMPEN�=RANCE AND ACW 18,27,
FOR
9
061CIALS SIGNATUP CLI
SIGNASOE (OWNEKOR AGENT DATE SIGNED
(425)
1, �l Al 0�1) il iAA I
7—/7—
771-0220
LA
DATE'
RELEAS
ATTENT16N
EXT 1333
7L
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTUREUNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
I OW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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