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CONSTRUCTION PERMIT APPLICATION 'JOB SUITE/APT#
ADDRESS
07 1/3" i)4,41_j FLAT NAMEISUBDIVISION NO. I LOT NO. NO.
MAILING ADDRESS I�D. FEE I
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ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
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STATE LICENSE NUMBER EXPIRATION
114162 1`1/�
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REQUIRED SETBACKS (Fr.)
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ADDITION 0 COMMERCIAL cowtxssce OR
El CHANGE OF USE
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REPAIR GRADING CYDS ( X FIT
REMARKS
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REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'D
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THIS PERMIT AUTHORIZES ONLY THE W RK NOTED, THIS PERMIT COVERS WORK TO
t: "I 10"111111 PROPERTY ONLY. ANY CONSTRUCTION ONTHEPUBuc
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Recording Fee
. DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PER ITAPPLIONTIO.: I..
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—
PERMIT LIMM. I YEAR- PROVI ED WORK IS STARTED WITHIN '.0 DAYS
Engr. Inspection
State Surcharge
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC ONBE F OF HIS OR HER SPOUSE, HEAR% ASSIGNS AND SUCCESORS
Traffic .hg to
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREE TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS WASHINGTON, ITS 0111OLM.1, 11111011ES, AND AGENTS FROM ANY AND
ALL CLAJMii FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR IND RECTLY
Fire Review
Receipt III
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDU E ANY REQUIREMENT OF RDINANCE
ANY CITY 0
n Oct!
Fire I sp on
Total Amount Due
NORLIMITINAWWAYTHE RYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapoinsp.
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT AM THE OWNER, OR THE DULY A THORtZED AGENT OF
APPLICATION APPROVAL
THE OWNER. 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
IN VIOLATION CODE OF THE $TAT OF WASH NGTON RELATING TO
FOR INSPECTION
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WCMKJAI��.I.JRAN.,� AND R.- I.-I!1
OFFICIALS SIGN TU E
DAT SIGNED
(425)
P-7- 0 -z-
771-0220
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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-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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INSPECTOR DATE APPHUVEU
SETBACKS .............
FOUNDATION:
Footing ............
Wall .............. ...........
Pier/Porch .................
Retaining Wall ..........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in .................
Commercial Final
HEATING:
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Gas Test ...............
I C"
Gas Piping .................
Equipment ............
Commercial Final
EXTERIOR SHEATHING
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NAILING ...............
FRAMING ...............
FIRST FLOOR FRAMING
-INSULATION ................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR VV-)
OCCUPANCY ..............
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