20020490.pdfi��A DATE RECEIVED
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CITY OF EDMONDS ZONE N U M BE R�&M - /J
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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OWNER NAMEINAME OF DUS17�"
7FHAMEISUBDIVISION NO. LOT NO. to NO.
'10 FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY ZIP EXISTING — PROPOSED�
ITELEPHONE
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NAME METER SIZE LINE SIZE OF FIXTURES ;TV QUIRED
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ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAIN—t, be
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VARIANCE OR CU SHORELINE OR ADI3# INSPEFTION 80 D
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STATE LICENSE NUMBER RE.'D POSTED
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER URIC 108/1FINAL INSPECTION REQ'D
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON TH EPU8`Q Grading Recording Fee
2 D REQUIRE
:3 OMAi (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL
t: SEPARATEPERM;SSION.
Engr. Review City Surcharge
P. TAPPLRCARO": T`g DAY'
PERMIT UMMt I YEAR - PROVI ED WORK IS STARTED WITHIN '80 DAYS Engr. Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC F OF His OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESOSS Traffic Mitigation Plan Chk Deposit 7
, ON BEHAL
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Review Receipt
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, AR SING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS Panmry. ISSUANCE OIF' THIS PERMIT SHALL NOT BE Fire Inspection Tota[AmountDue
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp. Receipt Ip
I HEREIVY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPROVAL
APPLICATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUT14ORIZED AGENT OF
Thin application is not a ponalt until signed by Ina
THE OWNEFL I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Bull
THEREBY. NO PERSON WILL BE EMPLOYED ding Official or Neater Deputy: and Fees arUe, Paid, and
TION; AND IN DOING THE WORK AUTHORIZED d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION ipti,acknowledg,dinspaceprov , .
WORKMENS COMPENSATIENCE AND RCW 18,27, OFFICIALS SIG14ATURE DATE
— I DATE, (425)
a'� 771-042.0 D E
MLE B IT,
ATTENTION EXT 1333 f -
400--/
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 - INSPEC R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER GOLD . ASSESSOR
10/01
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ..........
FOUNDATION:
Feeling ......................
wall........... I .............
Pier/Porch .................
Retaining Wall
Slab Insulation
PLUMBING:
Underground .............
Rough -in .. ............. ...
Commercial Final
H EATING:
GasTest ..: .................
Gas Piping ............
Equipment.................
Commercial Final
EXTERIOR SHEATHING
NAILING .................
FRAMING
FIRST FLOOR FRAMING
INSULATION ................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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