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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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THIS PERMIT AUTHORIZES ONLY THE Wo RK NOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. AN CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPLICATI N: 10MAYS
GRADINGIF�LL
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PERMITLIMIT.1 YEAR -PROVIDED WORK IS STARTED WITHIN ISODAYS
G R Ew FE
ENG. REIIEW FEES
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
S AND SUCCESORS
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGN ESORS
N FEE
ENG. INSPECTION FEE
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IN INTER' ST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY
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PLAN CHECK DEPOSIT
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CEE.90 TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
'BICH -
TO ENFORCE ANY ORDINANCE PROVISION.
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H OR LIMIT It, ANY WAY THE CITY'S ABILITY
TOTAL AMOUNT DUE
F—FORINSPECTION
JFE.IEIPTI,�511tl�r
t HEREBY ACKNONLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AND -. AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THEOWNER IAG TO CIPLYVATH CITY AND STATE LAWS REGULATING CONSTRUC
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IN VIOLATION OF �,E LABOR OF WASHINGTON RELATING TO
CTIC .... ... P--ded.
CODE OF THE STATE
WORKMEN S COMP: Ns�� URANCE AND RCW 18,27.
OFF T RE DATE
1
-
SIGNUURf(dili DATE SIGNED
(425)
425
( )
1 0 0
771-0222u
ELEASEofiY /DATE
ATTENTION
EXT 1333
IT IS UNLAWFULTO 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
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SETBACKS .....................
FOUNDATION:
Footing......................
wall............. ...... . ....
P16riPorch .................
Retaining Wall ...........
Slab Insulatler, ..........
PLUMBING:
Underground
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HEATING:
Gas Test ....................
Gas Piping ..............
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATIONF� ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NUMBER �200/ --I)A
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SUITIVAPTO
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PLAT NAMEISUBDIVISION NO.
LOT No,
LID NO.
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LID FEE S
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REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
FIRE REVIEWED By
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SERA REVIEW
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SIGN AREA
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HEIGHT
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010
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LOT COVERAGE
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Fift MARSH
FRONT UR SIDE REAR
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DESCRIBE WORK TO BE DONE
REM
REMARKS
In('RFqR INRIPIRCTICIMS PER U13C 1081FINAL INSPECTION REO'
r4vT el, 7 yr"-� 'al, 0(
LtUIVIrL r_ I EU
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE GILAZING % LOT SLOPE %
BUILDING
PLAN CHECK NO.. [ESTED OATI
PLUMBING
MECHANII AL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIRLL
S
DOMAIN (CURBS. SIDEWALKS, DRIVEWAY , MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PIE"MITAPPLICA" -; "g-AY-
PERMIT LIMIT'. I YEATI, PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MOREINFORMATION
ENO. REVIEW FEES
ENG. INSPECTION FEE
A P -T. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
P LICA
IN NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
D
AND AGENTS FROM ANY AND
LANDSCAPING
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES.
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE.ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
JRECIIPT
PLAN CHECK DEPOSIT
DE EMEOTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY TH E CITY'S ASIUTY TO ENFORCE MY ORDINANCE PROVISION.'
RECI��
TOTAL AMOUNT DUE 4 4i
I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION. 7 HAT THE IN FORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
:
-pph-ohl, not, p,,,,I,htil $ghad by the
THEOWNER. IAGREETOC MPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
0
CALL qu"Th"
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TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WI LL Bit EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION '-,I is acknowledged in @Pa. P-1d.d.
IN VIOLATION OF THE LABOR CODE
WORKMEN S COMPENS;;��VURANCE AND RCW 18.27.
OF�LPIAL SIGN UAE DATE
SIGNATUff WNER C"NT) I DATE SIGNED
(425)
164-161
771 220
-0 RELEASED Y
ATTENTION
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 CERTIFI- ORIGINAL - FILE - IELLO - INSPECTOR
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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