20020349.pdfPERMIT EXPIRES �22
PERMIT
CITY OF EDMONDS lu-S'E NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAME/NAMEOI SUSINUSS s
PLAT NAME —DIVISION NO LOT 10, L'Il NO,
MAILING ADDRESS LID FEE S
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THIS PERMITAUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS, MAROUEES. ETC.� WILL REQUIA E
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SEPARATE PERMISSION.
STATE SURC-AGE
PE MIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 16D DAYS
ENG REVIEW FEE S
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
END INSPECTION FEE
IN INT A ST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS N (F ON Y OF
LANDSCAPING
EDVO'NDES WA HINGTON, ITS OFFICIALS, EMPLOYEES ANDAGENTSFROM ANYANO
INSPECT ION FEE
R ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMI I SHALL NOT BE
DEEMEDT MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANG E
PLAN CHECK DEPOSIT
RECEIPT
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINAN cE PROVISION
AEG,
TOTAL AMOJNT DUE
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IHEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT, AND T iAT I AM THE OWNER. OR THE DULY AUTHOR12ED AGENT OF
APPLICATION APPROVAL
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATINO CQNST 8 UC
TION. ANDIN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE LMPLO� D
CALL
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IN VIOLATION OF THE L So THE STATE .1 WASHINGTON REt.AT!NG TO
FOR INSPECTION P'.
WORKMEN S COMPENSAAeINS GE AND RCW 18 27,
SIGNATURE (OWNER OR EN lAll SIGNED
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0 DATE
ATTENT�
EXT 333
UN
L F OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELIOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SEC1 ION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
2
SETBACKS .....................
FOUNDATION:
Footing......................
wall..........................
Pier/Porch .................
Retaining Wall
Slab Insulation
PLUMBINGi.
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Rough -in ...................
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Commercial Final
HEATING:,
Gas Test .............
Gas Piping ...........
Equipment..............
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING . ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation ..........
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
F14AL APPROVAL FOR
OCCUPANCY ................
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