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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER HAIAIINAMI 01 BUSINESS
MAILING ADDRESS
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STATE LICENS9 NUMBER EXPIRATION DATE
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�RGPERTY TAX ACCOUNT PARCEL NO.
005-5-5-13 QDI 003 00
0 NEW RESIDENTIAL CO] PL MBING/MECH
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0 REMODEL pg APARTMENT SIGN
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UBC 11081FINAL
VALUATION
FEE
PLAN CHECK FEE
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HEAT SOURCE GLAZING % LOT SLOPE
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PLAN CHECK NO: IVESTED DATE
PLUMBING
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
WAY E
DOMAIN (CURDS, SIDEWALKS, DRIVE S. MARQUEES, ETC.) WILL REQUIR
SEPARATE PERMISSION.
STATE SURCHARGE
APPLICATI N: 180DAYS
PERMIT LIMIT. I ..PERMIT
AR. PROVID DWORK IS STARTED WITHIN 1IDDAYS
ENG. REVIEW FEES
SEEBAC K OF PINK PERMIT FOR MORE INFORMATION
'A P ICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
P L
END INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY, DEPEND AND HOLD HARMLESS THE CITY OF
LANDSCAP NO
EDMONDS. WASHINGTON, ITSOFFICIALS. EMPLOYEES, ANDAGENTS F Rom ANY AND
INSPECTION FEE
M ALL DIRECTLY
CI -AIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR IN
RECEIPT
FROM THE ISSIA IE 011"" PERMIT ISSUANCE 11 THIS Pll"IT SHALL NOT 11
To MODIFY. WAIVE OR REDU E ANY REQUIREMENT OF ANYCITY ORDINANCE
PLAIN CHECK DEPOSIT
0 NOR LIMIT IN ANY WAltTHE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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cEtIPT/6,3,9_5�
TOTALAMOUNrDUE
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I.IiEREDY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
APP ICATION APPROVAL
LVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
HE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
T OWNER IAGREE
CALL
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
I N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
1
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FOR INSPECTION
WORKMEN 5 COMPENSATION INSURANCE AND ACW 18,27
OF IALIIIIIATI��,,,. DATE
SIGNATURE (OWNER oZ� �NT _fATE 116NED
(425)
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771-0220
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01,51
ED a DATF
ATTENTIOA
iEXT 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 CERTIFI-
ORIGINAL -FILE - YELLOW-IN5F,6 TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER - GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ................. ...
FOUNDAMON:.
Footing..............
wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Undorground .............
Rough -In ...................
Commercial Final
HEATING:
GasTest ....................
f
Gas Piping .................
Equipment ..............
commercial Final
EXTERIOR SHEATHING
NAILING .................
FRAMING .................... ...
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling insulation
SHOETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
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CONSTRUCTION PERMIT APPLICATION
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDFIAINAGE
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NAME
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4 EXPIRATION DATE 11 BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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0 REPAIR GRADING CYDS X FT)
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(TYPE OF USE, BUSINES&�yr;:;N
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NUMBER NUMBER OF I CFIl)CAL
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STORIES OWELLIN NUMBER
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FIRE REVIEWED By
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ALLOWED PROPOSED
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FRONT SIDE REAR
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RECID I PROVIDED
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ROGRIESS INSPECTIONS PER UBC 11081FINAL INSPECTION REO'Dl
P .0 ... SINS,
VALUATION
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PLAN CHECK FEE
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HEAT SOURCE GLAZING %
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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
GRADINGIFILL
E - U I E
L L U
OMAtN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL ED IRE
SEPARATEPEFIMIS�10�.
S�ATE SURCHARGE
PERMIT ..1.4tio-v 140 t,.AYS
A Y S
PERMIT LM�r R . PROVIDED WORK 15 STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
X., PINK PERMIT FOR MORE INFORMATION
BE Ar
ENG. INSPECTION FEE
CE S PS
N D .U. 0
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
;APPLICANT.
TV
T I OF
SS E C
N NTEREST. AGREES TO;NDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
S FR. AN Y AND
EDIMONDS. WASHINGTON. TS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
-Y 'N.'PEC'Ly
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
—RECEIPT
IT S-AL NOT BE
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
CITY ORDINANCE
D=T=FY, WAIVE OR REDUCE ANY REOUtREMENTOF ANY CITY ORDINANCE
PROVISION
PROVISION.'
NCE
0 N T WAY THE CITY*S ABILITY TO ENFORCE ANY ORDINANCE
RECEIPT/5.3lr
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. TAT THE INFORMATION
APPLICATION
APPROVAL
IS CoRftEC , Z G E '
GIVEN T. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT 01
E WIT. CITY AND STATE LAWS REGULATING CONSTRUC-
THE OWNER, I AGRE 0 L'
To COFMtKPAUTHOSIZED
CALL
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CA L
um",, I,—, O.p.ty:.nd F. t.. p.d
, L BE EMPLOYED
TION; AND IN DOING 7 THEREBY. NO PERSON WILL BE EMPLOYED
L , To
WASHINGTON RELATINGTO
FOR INSPECTION
0 S
,,pt 11 1�kl�dpd 1, $POW PwvIftd
IlVIO-IONOFTHH'W R CODE OF THE STATE OF
LA So
WORKMEN S COMPENSATION AND RCW 18.27.
OF IALS SIGNATURA DATE
MRANCE
DATE SIGNED
(425),
4 �0/,j
SIGNATURE (OWNER Oe!-NLV
L., 6
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A A..
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771 _0220
771-0220
R ED BY I MITE
ATTENTION
EXT 1333
Alk
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-
1111INAL-11LE - YEIIOW-INSPEbTO
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
-A
FAX
PINK -OWNER - GOLD -ASSESSOR
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