20010851.pdfDATE RECEIVED
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I PERMIT EXPIRES
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I= BEDONEON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS' MARQUEES. ETC.� ViILL REOUIRE
SEPARATE PERMISSION.
—
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t� SURCHARGE
PERMIT APPLICATION: 180 DAYS
A. PERMIT LIMIT� I YEAR . PAOV'o ED WORK IS STARTED WITHIN 190 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END REVIEW FEES
;ArPLICANT, ON BEHALF OF HIS OR PER SPOUSE, HEIRS, ASSIGNS AND SUCCSSORS
DEFEND AND HOLD HARMLESS THE CITY OF
N NTEREST, AGREES To INDEMNIFY RO. ANYAND
EDMONDS. WASHINGTON, ITS OFFIC`LS� EMPLOYEES. AND AGENTS I
ALL CLAIMS FOR DAMAGES I WHAT EVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FR M THE ISSUANCE Or THIS PERMIT. ISSUANCE 01 THUS PERMITISNALL NOT BE
DEEMEDT MOOIFY. WAIVE OR REDUCE ANY REQUIRE.ENT OF ANY C Ty ORDINANCE
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NOR LIMIT IN ANYWAY THE CITY S ABILITY TO ENFORCE ANY RDINANCEPROVISIO.
ENG. INSPECTION FEE
rLANDSCAPING
INSPECTION FEE
BP ECTON FEE
- PEC K BE PCS'T
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
tHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN 1 5 CORRECT. AND THAT I AM THE O,NINEF. OR THE E1.1 AUTHORIZED AGENT I
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING C.INSTAUC
TION. AND IND ING THE WORK DTHEREB - NO PERSON WILL BE EMPLOYEE
IN VIO ONO T LABOR CODE 0 HE STATEYOF WASHINGTON RE ATING T
,I OF HE
WORKMEN S COMFENSATIPN INED RANC AND RCW 18,27.
CALL
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ITI UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
TAINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
�T..,
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
WWI ...............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
P LUMBING:
Underground.............
Rough -in ...................
Commercial Final
HEATING:
GasTest ....................
Gas Piping .................
Equipment . .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
d"
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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SEE BACK OF PINK PERMIT FOR Mont INFORMATION
I. N A N �UCCES-RS
'A HIS OR HER SPOUSE. HEIRS. ASSIGNS ANDAUCCESORS
PPL'CA"T ON HALFTOF
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ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
RECEIPT
ERM L T
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A CE OF THIS PERMIT SHALL NOT BE
ROM THE ISSUANCE OF THIS PERMIT. ISSU N
PILAN HECK DEPOSIT
P LAN C ECK EPOS'T
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF A NYCITYORDINANC E
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PC NANCE PROVISION
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0 NOR LIMIT ll�l ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIS'ONL
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TOT L 0 1 T U 1"
TOTAL AMOUNT DUE
C17?
T T I , M T,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE IN FORMATION
I
GIVEN'IS CORRECT, AND THAT I AM THE OWNE R. OR TH E DULY AUTHORIZED AGENT OF
T."
G
THI?bWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
I To RELATING TO
WASHINGTON R
FOR INSPECTION
0 1 Sp TIC
I N VIOLATION OF THE LABOR CODE O� THE STATE OF
WOR�MEN'S COMPENSATIPN INSURANCqAND RCW I 8.27.
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-
SIGN RE NER R GENT)
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DATE 11
(425)
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A 1
44
1 0 0
771-0;2i�20
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EXT 333
A#EIRITION
gVUNLAWFULT0 USE OR OCCUPY A BUILDING OR STRUCTURE UN L
771-0221
A INAL NSPECTION HAS BEEN MADE AND APPROVAL OR A CERTfFlI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
DATE
ALLOWED I PROPOSED
PROPOSED SETBACKS IFT)
FRONT—UR SIDE FEAR
0 CUPANT
C ,
GROUP,�
IOU
OCCUPANT
LOAD
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INSPECTION FIE.'. q
)N APPROVAL
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YELLOW INSPECTOR
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