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DOMIMN (CUR13% SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPAPATEPERMISSION.
Engr. Review City Surcharge
PER ITAPPLICATION; 100DAYS
PERMIT LIMIT I YEAR- PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATIO14
*APPUCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND MOLD HARMLESS THE CITY OF
EDMONDS,Ik�SHINGTON, OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review Receipt #
ALLCLARASFO DAMAGES F WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROMTHEISSUANC OFTHISPERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAAVC OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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Landscapemsp. Receipt #
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I HERE13Y ACKNOWLE BE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I Am THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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IN VIOLATION OF THE n CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION 1-1PI I—R-109nd Irp ... p—Idnd.
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A BUILDING OR STRUCTURE UNTI L
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BEEN MADE AND APPROVAL OR A CERTIFi-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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RECORD OF INSPECTIONS
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INSPECTOR
DATE APPROVED
SETBACKS ....................
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FRAMING ... ...........
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INSULATION ..............
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Floor Insulation
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Wall Insulation ...........
Coiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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