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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
MNER NAMEINAME OF BUSINESS
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PERMITEXPIRES
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTF12UGRAINAGE " 11
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LUMBINGIMECH
LOT COVERAGE REQUIRED SETBACKS (Fr) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED MONT SIDE REAR FRONT URSIDS REAR
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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GARAGE RETAINING WALL
RENEWAL
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REMARKS
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Mechanical
THIS PERMIT AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORKTO
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BE DOME ON PRIVATE ONM ANY CONSTRUCTION ON THE PUBLJ
PROPE— Ic
Grading
Recording Fee
DOMADI (CURB$, SIDEWALKS.0 RC WILL .our
SERA RIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
FLATEPERMISSION.
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Engr, Review
City Surcharge
PERMIT APPLICATION: ISIDAYS
PERMIT LIMIT I YEAR"PROVI ED WORK IS STARTED WITHIN IGODAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
'APPLICANT ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, A61IGNI AND SUOC11011
Te-C ""gallon
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Receipt #
EDMONDS' WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHAT= R, NATURE ARISING DIRECTLY OR INDIRECTLY
THE ISSUANCE OF THIS PERMIT. SSUANcj OF THIS PERMIT SHALL NOT BE
Fire Review
Total Am cunt ()Us
FROM
DEEMED TO MODIFY, WAIVE Orr REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
0 NOR LIMIT IN ANY WAY THE CITYa ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
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I HERESY ACKNOWLEDGE TH E READ TH S APPLICATION: THAT THE INFORMATION
1 HAAVTHE
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT GARIN. OR THE DULY AUTHORIZED AGENT OF
STATE LAWS REGULATING CONS TRUC
51
TrIff.ppilawl.alaraff.p.nall-i sipodlaythe
THE OWNER. I AGREE To COMPLY WITH CITY AND
TION; AND IN DOING THE WOBK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
CALL
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Bellding official a, hieff,c, Dore : andFoas are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION recorpt is 111,11111d9ld inapaw provided.
WORKMEN'S COMPENSATION INSURANCE AND ACW 18.27.
OF A" SIGNATURE
SIGNATURE (OWN GE DATE SIGNED
(425)
2—
771-0220
'RELEASED By DATE
A17ENTION
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. LED SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:
Footing ......................
Wall ......................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
5i
.............
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IT! 0
Rough -in ...................
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0
Commercial Final
171
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HEATING:
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10-4
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Gas Test .............
Gas Piping .............
Equipment ............. . ..
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Commercial Final
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EXTERIOR SHEATHING
NAILING
0
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FRAMING ...........
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FIRST FLOOR FRAMIN G_
INSULATION ...................
Floor Insulation
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Wall Insulatl on ...........
Colling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................