20020082.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDRESS 11111 , 15�_
PLAT NAMEISUDDIVISION NO.
LOT NO,
LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE
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NO. OF FI11URE1
IRV REQUIR
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY DATE
TELEPHONE
STATE. LICENSE NUMBER
EXPIRATION
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
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YES C3 NO
PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
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Building
PLAN CHECK N� VESTED DATE
Plumbing
THIS PERUIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WGRKTO
d�
Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTIR IONONITHEPUBUC
a
Grading
Recording Fee
DCHAMN (CURBS, SIDEWALKS, DRIVEWAYS UMQUEES, ETC.) WILL REQUIRE
n SEPARASEPERUISSION.
IC
PFRILUTAPPLICATION. ISIDAYS
Engr. Review
City Surcharge
PERMITUAII IYEA -PROVIDED WORK IS STARTED WITHIN 18DDAYS
119�GIVE
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE, HEIRSASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
;APPUCAK
N INTEREST. AGREE TO INDEMNIFY. DEFEND AND HO D HARMLESS THE CITY OF
EDMONDS, WAIIIINGTON, ITS 11111111U`F EMPLOYEES, AND AGENTS 1111111 ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
Receipt #
FROM THE I SUANCE OF THIS PERMIT ISSUANCE P THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE CJWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapeinsp.
Receipt #
IHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
IS CORRECT. AND THAT I AM THE OWNER, OR THE DUI� AUTHORIZED AGENT OF
APPLICATION APPROVAL
X
T E OWNER, I AGREE TO COMPLY WITH City AND STATE LAWS REGULATING CONSTRUC-
CALL
T his application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
S ailding Offidal a, nether Deputy: led Fees are paid, and
dentin Is arkemkIdged In space p viand.
WORKMEN's COMPENSATION INSURANCE AND ACW 18.27,
DATE SIGNED
(425)
VAL )G.ATU.E DATE
FF C
0 1
,
771-0220
7REET-EASED BY DATE
ATTENTION I
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-
ORIGINALIF+d YELLOW - ' INSPE16TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
10/01
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...........
FOUNDATION:
Footing......................
wall
Plar/Porch
z
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
IT! N
0
0
Rough -in .............
0
Commercial Final
R!
HEATING:
2Z
Gas Test ....................
Gas Piping ............
0 -n
Equipment .................
3:
Commercial Final
ITI 171
EXTERIOR SHEATHING
NAILING ............ ..........
0 f
FRAMING .....................
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FIRST FLOOR FRAMING
z
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INSULATION ...................
Floor Insulation
Wall Insulation . ..........
Ceiling Insulation
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0