20015563.pdfDATE RECE �5
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT LIMIM I YEAR � ROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-AP PLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
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- ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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ml FR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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PLAN CHECK DEPOSIT
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DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF ANY TYORDINANC
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CONNECT AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
THE 0 INER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMP DYED
I N VIOLATION OF THE LAB CDE OF THE STATE OF WASHINGTON RE L ATING TO
FOR INSPECTli
WORKMENSCOMPENS NCE ANDRCW 16 27
SIG7NAE 101NIR AGINII Dl��7
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771-0220
ATTENTION
EXT 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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FINAL PROJECT APPROVAL FORM
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date— Sign_
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
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Footing
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Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulatl on
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Gas.Plping .................
Equipment .................
commercial Final
EXTERIOR SHEATHING
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FRAMING ........................
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FIRST FLOOR FRAMING
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Floor insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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FINAL APPROVAL FOR
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CONSTRUCTION PERMIT APPLICATION
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Do MAIN jCURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PER�Issl`)N.
PERMIT APPLICATION; IBDDAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WI HIN 180 DAYS
ENG. REVIEW FEES
SEE BACK 01 PI NK PERMIT FOR MORE I.FO.MA
1 I
P PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
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N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
MoNDS.WASHINGTO , I s OFFICIALS, EMPLOYEES. AND AGENTS FROM ANYAND
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. FR M THE ISSUANCE OF T IS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT BE
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01 DEoEMEDTOMODIFY.WAIVEOR REDUCEANY REOUIREMENTOF ANY CITY ORDINANCE
.
01 'so
NOR LIMIT IN ANYWAY THE CITY�S ABILITYTO ENFORCE ANY ORDINANCE PROV I N.
TOTAL AMOUNT DUE
RECEIP
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I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICAT ON APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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OWNER. I AGREE To COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC
THE -
CALL
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TION AUTHORIZED THERE BY. NO IE ASON WILL BE EMPLOY ED
IN VI AND IN DOING TH 0 DE OF THE STATE OF WAS INGTON RELATING TO
0 THE
FOR INSPECTION
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WGROLATISN
KMEN CGMPENS NCE AND ACW 18.27.
1
(425)
FF IALS SIGNATU DATE
SIGNATFE (OWNER DATE �7,D
771-0220
A SED BY DATE
EXT 1333
1., 11
'5111ell I
ATTENTION
ITISUNLAWFULTOUSE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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