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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE
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REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION RED'
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BUILDING
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PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
-
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADING FILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
PERMIT AIPLIIATI..; 100 DAYS
STATE SURCHARGE
PERMIT UMIT.'I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
NO R E_ EW FEE S
END REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
PENFEE
. SP T 0
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ENG INSIECTIONIEE
EN N
-APPLICANT ON BEHALF OF H15 OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
1. NTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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LANDSCAPING
LANDSCAPING
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EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND A ENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE.ARISIN DIRECTLY OR INDIRECTLY
IN �PECT'ON FEE
INSPECTION FEE
RECE111
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM T SHALL NOT BE
PLAN CHECK DEPOSIT
3
133222
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT F ANY CITY ORDINANCE
.1 NOR LIIAIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
IR CE
17 2-
11
TOTAL AMOUNT DUE
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
CONSTRUC-
1 ppl.cal-.1 lb, A PY-It .01 ApId by t1l
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
TION NO PERSON WILL BE
CALL
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AND IN DOING THE WORK AUTHORIZED THEREBY. EMPLOYED
IN VIOLATION OF THE LABOR ODE OF THE STATE OF WASHINGTON RE ATING To
FOR INSPECTION d 0-
SEgMPENSATION IINSURANC E AND RCW 18-27
OF14ALS SIGNATURE DATE
(425)
�n J I JAAAA
771-0220
By
ATTENTION
EXT 1333
7)��ED
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
77 11 -022 1
'L
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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APPROVED BY PLANNING SITE PLAN Nc NTRACTOR SHALL
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CONNECT NEW
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...............
FOUNDATION:
Footing......................
Wall. . ........................
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PleTIporch .................
R.IaWng Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
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Gas Test ....................
Gas Piping
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Equipment .................
commercial Final
EXTERIOR SHEATHING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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CONSTRUCTION PERMIT APPLICATION
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G�DINGIIILL
2 DOMAIN (CURIML SIDEWALKS. DRIVEWAYS, MARQUEES. ETC,) WILL REQUIRE
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n SEPARATE PERMISSION.
STATE SURCHARGE
PERMITAPPUCATI N: 180DAYS
PERMIT LIMIT: I YEAR, ROWDED ORK IS STARTED WITHIN ISOCAYS
p W
ENG. REVIEW FEES
',SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
PLICANT. ON BEHALF OF HISS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
;A
�PNTEREST. AGREES TO IND MNI�, DEFEND AND HOI.D HARMLESS THE CITY OF
ANY AND
"NOSCAPING
a EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FRO.
ALLC�IMSFOR A�GES OFMATEVER NATURE. ARISING DIR ECTLYOR! ..........
INSPECTION FEE
FROM THE ISSUANC OF THIS PERMIT SS ANCE OF THIS PERMIT SHALL NOT BEE
PLAN CHECK 06POSIT
0 DEEMEDTO Mo., FY.LAIVEORREOU E ANY REQUIREMENT OF ANY CITY ORDINANC
0 NOR LIMIT IN ANY WAY THE CITY S ABILITY TO "FORCE ANI ORDINANCE PROVISION,"
S
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE TH -AVE �SADTHISAppj.JCATI�N.T�AT EINFORMATIO.
GIVEN IS CORRECT, AND T= AM THE OWN E OF THE OLLY AUTHORIZED AGENT OF
AT
THE OWNER. I AGREE TO C OMP Ly WITH CITY AND STATE LAWS REGWLATI�G CONSTRUC-
CALL
TION, AND IN DOING THE WORK AU HORIZED THEREBY. NO PERSON WILL BE E"' 0"'
THE CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIOLATION OF LABOR
AND R(r 18.27,
W,042�
AMPEN:��SURANCE
SWINER d4kZ�) i
DATE SIGNED
(425)
jf�_
771-0220
EXT 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 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
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