20010707.pdfD
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRAJIUN —
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SERA
COMPLLETE �EXENIPT
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ALLOWED PRO"
PROPERTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE
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QUIRED SETBACP
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CHANGE OF USE
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MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU UBUC
DOMAIN (CURBS. SID.IYALKS. DRIVEWAYS , MARQUEES. ETC.) WILL RED IRE
SEPARATE PERMISSION.
GRADING(FILL
PERMIT APPLICATION: IBDDAYS
KI
PERMIT LIMIT. I YEAR -PROVIDED WOR SSTARTEDWITHIN lBoDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG� REVIEW FEES
PHI OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
PL"A,NST�.'AN."E"ALTFo',..�S..IFY. DEFEND AND HOLD HARMLESS THE CITY
IN INTER R ES
E WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANYAN'
ADMONDS.
E
U. CLAIMS FOR DAMAGES OF WHATEVER NATURE� ARISING CIA CTLYORINDIRECTLY
FROM THE ISSUANCE OF T IS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
N
DEEMED TO MODIFY. WAIVE 0. REDUCE AN' REQUIREIAENTOF AN' CITY ORDINANCE
0 NOR LIMIT IN ANYWAYTHE CITY�SABILITY TOENFORCE ANYORDINANCE PH—..—
SEND, INSPECTION FEE
FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE RECE;12�35
IHEAEBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
THEoWNER I AGREE TO COMPLY WIT. CITY AND STATE LAWS REGULATING CONSTFUC-
P E
AND IN DOING THE Wt7rK AUTHORIZED THEREBY. NO PER50N WILL BE E. LOY D
N �'OLAT ION OF THE LABOR CODE Or TIIE STATE OF WASHINGTON RELATING TO
L_�?�I.E��CoMPENSATIO!NN;I;TN;);SURANCE AND ACW IB 27
DATE SIGNED
APP
CALL T pplk
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FOR INSPECTION
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(425)
771-0220
ATTENTIOf4
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A 13UILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- FAX
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109 PIN
S.ss
DATE
DWED I PROPOSED
SETBACKS (FT.)
AR
DATE
OCCUPANT
G ROUP
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LICATION APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
i
Footing
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In r ...................
Commercial Final
HEATING:
%
Gas Test ....................
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
OCCUPANCY ..................
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PERMIT EXPIRES
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ZO PERMIT
NUMBER
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OF BUSINESS
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PLAT NAME/SUB01VISION NO.
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NO,OFFIXTURES
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YES 13 No 13
ADDRESS
REMARKS
OWNE�ONTRACTOFI RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ITILEPHON1
NAME
AENGINEERING
ADDRESS
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REVIEWED BY DATE
CITY ZIP
TELEPHONE 7
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2,41
VARIANCE OR CU SHORELINE OR ADBR INSPE
L NUMBER CH
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YoOKELA 06(1 14
SERA REVIEW
SIGN AREA
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT
ALLOWED I PROPO ED
ALLOWED PROPOSED
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EXP
LOT COVERAGE
RE061AED SETBACKS I".)
PROPOSED SETBACKS (FT)
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'rm'r.RESS INSPECTIONS P�R Usc ioS/FINAL INSPECTION REQ'D
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VALUATION
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BUILDING
PLAN CHECI4!2,,:,,
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT C.1— WU.X
t: BEDONUON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUSUC
GRADINGIFILL
DOMAIN (CLASS. S'..LKS, DRIVEWAYS , MARQUEES. ETC.) WILL REQUIRE
SEPARATE P�RiiISSIIDN.
- 'm
PE Fr 4 CAYS
A. PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
ENG. REVIEW FE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
N NTEREST, AGREES TO INDEMNIFY. DEFIEND AND HOLD HARMLESS THE CITY OF
I
ENO. INSPECTION FEE
)emib.Amo
Cl I.S. EMPLOYEES, AND AGENTS FROM ANY AND
EDMONDS, WASHINGTON. ITS OFFi 4
A CLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
R E C E 12
FLL SHALL NOT BE
ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT E
DEEMED TO MODIFY.WAIVEOR REDUCE ANY REQUIREMENTOF ANYC TYORDINANCE
p NCHE K DEPOSIT
1 -2
'OR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE My ORDINANCE PROVISION.'
TOTAL AMOUNT DUE
R CEI
"HEREBY ACKNOWLEDGE THATIHAVE READ THIS APPLICATION THATTHE INFORMATION
APPLICATION'APPROVAL
Gl�EN IS CORRECT, AND THAT I Am THE OWNER OR THE DULY AUTHORIZED AGENT OF
THE OWNER. IAGREETO COMPLY WITH CITY AND STATE LAWS REGULATING CMSTRUC-
CALL
III
B."T li� D.puty: m�d F-1. P. C
ION, AND IN .01.. THE WORK AU HORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RE ATING TO
FOR INSPECTION
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N VIOLAT ON OF THE LABOR DE OF THE STATE OF WASHINGTON
I I GOT
WORKMEN SCOMP N MNCEANDRCWIB.27.
0 GIALS SIGNATU
E SIGNED
(425)
:;��NE,RrGENIT)
771-0220
A Y
DATE
ATTENTIOfi
EXT 1333
IT IS UNLAWFULTO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX PINK -OWNER - GPLD&ASSESSOR
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