20020252.pdfAkr4il DATE RECEIVED
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CONSTRUCTION PERMIT APPLICATION JOB
OWNER NAME/NAME OF BUSINESS ADDRESS
FLAT NAMEtSUSDIVISION NO. LOT NO, LIDP(O.
LID FEE S
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CITY EXISTING — PROPOSED— en- a.'- 0
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REQUIRED DEDICATION "T
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ADDRESS 119111W YE C3 No 13
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STATE LICENSE NUMBER EXPIRATION
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INSPECTION
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REQUIRED SETBACKS (FT.)
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PROPOSED ETBACKS (Fr.)
FRONT L18ASIDE REAR
ADDITION [3 C MPLIANCE OR
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REMARKS
11, PER USC 1081FINAL INSPECTION REOD
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1PRO1"5 %11��TIIDNS
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Plan Check
HEAT SOURCE GLAZING LOT SLOPE
Building
4L'
TED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1: 0 DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
US
2
Grading
Recording Fee
ETC) IN A Go .
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, C.) WILL EQUJIFtE
1= SEPARATE PERMISSION,
Engr. Review
City Surcharge 16-
9 PERMIT APPLICATION I.DAYS
PERMIT LIM . I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON RENAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS 11011 ANY A""
Fire Review
Receipt #
ALL CLAAMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA CE
-
Fire Inspection
Total Amount Due
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapoinsp.,
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL'
GIVEN IS CORRECT%, AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STAT LAWS REGULATING CONSTRUC '
CALL
T appi callon Is not a pamut until signed by Me
TIM; AND IN DOING THE We K AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYE D
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE�TIHO To
FOR INSPECTION
Supplue
no 01021 or hialhad Deputy: and Fees am paid, and
nuairs 1, aokn..l.dg.d In sp ... pm,idtul,
WORKMENS COMPENSATION I=NCE AND RCW 18.27.
DATE
SIGNATURE (OWNER DATE SIGNED
(425)
!��n
771-0220
BY
E14TAN
EXT 1333
&SED
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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 :11,18ACTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footlng ......................
wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation
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PLUMBING:
Underground .............
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Rough -in ....................
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Commercial Final
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HEATING:
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Gas Test ...................
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Gas Piping ..........
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Equipment
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Commercial Final
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING-
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INSULATION ...................
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Floor Insulation
Wall Insulation . .......
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Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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