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CONSTRUCTION PERMIT APPLICATION
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REVIEWED/DATE
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CITY
FIRE REVIEWED By
DATE
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STATE LICENSE NUMBER DATE
VARIANCE OR CU
SHORELINE OR ADB# INSPECTI N BOND
REGG POSTED
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PROPERTY TAX ACCOUNT PARCEL NO.
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ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
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FRONT SIDE BEAR FRONT LIRSIDE RW
ADDITION
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CHANGE OF USE
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DATE
REPAIR
0 GRADING
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REMARKS
0 DEMOLISH
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o RETAINING WALL
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PROGRESS I SPECTIONS PER UBC 1081FINAL INSPECTION REO'D
VALUATION $
LOT SLOPE %
Building
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Plumbing
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS
PERMIT C 7v�
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BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN SIDEWALKS,
Grading
Recording Fee
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(CURES. DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION.
—
PERMITAPPLICATION INDAYS
Engr. Review
City Surcharge
4
PERMIT LIMIT. I YEAR - PROVIDED WORK 15 STARTED WITHIN ISO DAYS
Engr. Inspection
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State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I
%PPLICANT ON BEHALF OF HIS OR HER IFOUSE,HEIRS ASSIGNS AND SUCC SORS
IN INTEREST, AGREES TO INDEMNIFV. DEFEND
Traffic Mitigation
Trail..'
Plan Chit Deposit
AND HOLD HARMLESS THE CITY 01
EDMONDS, WASHINGTON, Its OFFICIALS, EMPLOYEES, AN" AGENTS FROM ANY AND
ALL CLAIMS PC DAMAGES OF WHATEVER MATURE, ARISING DIRECRYOR INDIRECTLY
Fire Review
'.I.
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
kFv. '.c.
Total Amount Due
NOR LiMir IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
La.".
Landscapemsp,
Receipt #
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIONi THAT I HE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC�
CALL
ThIS appliculkin Isnot a pemit until 91 u bylit.
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
WORKMENG CON RCW 18.27.
11
FOR INSPECTION
Building GOMM .1 hituhn, D.Futy: ivid Fu.'.'V. p.1d.
SIGNAT E (OWNE AD E
(425)
OFFICIALS SIGNATURE DATE
771-0220
,4,7L /A/h
--AlTENTION
EXT 1333
- / TIME
91 q
W� 11h,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221
CATE OF OCCUPANCY HAS BEEN GRANTED. ORIGINAL - FILE YELLOW INSI`ECTOR
10/01 URIC SECTION 109 FAX PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...................... . ..
Pier/Porch .. ..............
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Retaining Wall ..........
Slab Insulation
2�
PLUMBING:
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Underground . ................
Rough -In
M
C
...................
Commercial Final
0 C
HEATING:
M
M z
Gas Test ....................
C
Gas Piping .................
>
Equipment
Commercial Final
0 n
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EXTERIOR SHEATHING
M ITI
NAILING ....................
0
FRAMING ..........
0
FIRST FLOOR FRAMING
M 0
INSULATION ................... .
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Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETSOCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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