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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEVEI A IN S_
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MAILING ADDRESS
CITY
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[PERMIT EXPIRE7S
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LID FEE 5
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ
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PLAN CHECK FEE
VALUATION FEE
HEAT SOURCE GLAZING
WILDING
PLAN CHECK NO:
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—
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ONLY ANY CONS' RUCTION ON THE PUBLIC
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ENG REVIEW FEES
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SEE BACK 0; PINK PERMIT FOR ORERINFcnmATION
w 'APPLICANT, ON BEHALF OF HISORHERSPOUIE EIRSLA ON ANDS CCESORS
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OFE
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ALLCLAIMS FOR DAMAGES
PERMIT SSU�p ERMIT SHALL NOT BE
ISSUANCE OF THI .6E OF Ep
PLAN CHECK DEPOSIT
FRO THE
M N EGUIREMENT OF ANYCITY ORDINANCE
DEEMED TO MODIFY. WAIVE OR REDUCi A YA
PROVISION.'
RE
0, NORLI�ITINANYWAYTHECITY'SABILiTy TO ENFORCE ANY ORDINANCE
TO L AMOUNT DUE
APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS
GIVEN 15 CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSTRUC�
ALL
T�l;
THEO NER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
7 NO PERSON WILL BE !MPLOYED
ION AND IN DOING THE WORK AUTHORIZED THEREBY. T
RE ATING 0
CALL B." d, D
C .�kl—.
FOR INSPECTION 'p... P- 9
I N VIOLATION OF THE LABOR CODE OF HE STATE OF WASHINrTON
OFFICIA GNATURE TE
WORKAEN 550M�ENSATIO�ANCE ANDRC- 1827
(425)
11 1�
t
DATE
771-0220
RE EA ED By
EXT 1333
A7ZE N N.
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SE 0 (B 08 STRUCTU8E UNTIL 771-0221
IT . LT f OCCUPY
O� CC-'Y
&=�AXI)E
A FINAL INSPEC ANO APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
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Slab Insulation ..........
PLUMBING: j
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Underground .............
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Commercial Final
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Gas
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as Piping ...............
n
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
W
Floor Insulation
Wall Insulation ...........
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0
Ceiling Insulation
0
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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RMIT EXPIRES
CITY OF EDMONDS
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS c9lb op"
—Nl;2;7AlE11111'lNr�
7060 / C
FLAT NAMEISUBDIVISION NO.
LID NO.
AA,
LID FEE $
1.
MAILINGADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
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0
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LINE SIZE NO*OFlIXTURES
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9 E3 NO 0
REMARKS
OWNEITCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP ITELEPHONE
NAME6W
Z0,90
ENGINEERING REVIEWEDIDATE
Ia ADDRESS j"P IV -'30)C K1,
REVIEWED BY DATE
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VARIANCE OR lU
STATE L DENSE NUMBER
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SERA REVIEW
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El CHANGE OF USE
.
PARKING L
T AREA
PLANNING REVIEWED
By DATE
REMODEL
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0 REPAIR ( X _ FT)
REMARKS
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REMARKS
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VALUATION
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DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE W FIX NOTED. THIS PERMIT COVESISLWORK TO
t:
B E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUESS. ETC.) WILL AEOUIRE
SEPARATE PEM11SE.
STATE SURCHARGE
PER. ITAPPLICATICk'IleD DAY
P AT
PERMIT LIMIT: 1 YEAR ROVIDED WORK 15 STA ED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE SACK OF PINK PERMIT FOR MORE IN FORMATION
ENG, INSPECTION FEE
P ICANT. 0 LF HIS OR HER SPOUSE. HEIRS. ASS] NSAN SU ES AS
;A
N TEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HA LESSTHE ITY F
ENTSFR ANYAND
NDSCA ING
FEE
ED' ONDS,WASHlNGTON. ITSOFFICIALS. EMPLOYEES.ANDA
DI ECTLY RINDIRECTLY
�j
ALLCUUMSFORDAMAGES E OF THIS PERMIT SHALL NOT BE
PERMIT IIIIANC
INSPECT71 N
PLAN CHECK DEPOSIT
FROM THE ISSUANCE 11 THIS
DEEMEDT MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANY CITY ORDINANCE
0
10
NORLIMIT N ANYWAY THE CITY'SABILITI TO ENFORCE ANYORDINANCE PROVISION,
TOTAL AMOUNT DUE
RE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZEDAGENT OF
NO CONSTRU%
REG ULATIL
CALL
I.E. NER. I A..EET.CO.P-WIT. CITYA�. STATE LAWS
W BE EMPLOYE
THEREBY. NO PERSON WIL
B,,Id,,g I �dFlololll�poa,dd
AND IN DOING THE WORK AUTHORIZED
ION. WASHINGTON RELATING TO
IN VI LATION OF THE LABOR 410DE OF THE STATE OF
PR, INSPECTION
.
WORKOMEN Sq0MeENSATIOHJKSURANCE AND RCW 18,27.
DAJE SIGNED
7
(425)
0 FIC A ON
�.WNE
771-0220
RELEA EDBY
RE
EXT 133 3
A'��EN ��N
-_O
NLA3 ILDING OR STRUCTURE UNTI
Upy
CU Y
IT To C
0!
�LNIPADE
L
771-0221
A IN HAS Al D APPROVAL� OR A CERTIFI-
FINAL INSPECTID� �=N_
OnIGINAL - FILE' YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD - ASSESSOR