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CITY OF EDMONDS Z'NE g PNUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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FRONT SIDE AFAR FRONT
SETBACKS (FT)
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REMARKS
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NUMBER OF
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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State Surcharge
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Building Permit
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City Surcharge
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PLAN CHECK NO:
—
VESTED DATE
Plumbing
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30-
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO
I: BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
.2 0
I OMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
Engr. Review
AS AMITAPPLICATION: IN DAYS
Engr. Inspection
PERMITUMMIYEAR -PROVIDED WORK 15 STARTED WITHIN INDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt If
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARBING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MOD]ffWAWE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapemsp.
Total Amt. Due i
/!3q
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt # 1190AIV
I HEREBY ACKNOWLEDGE THAT I HAVE BEAD THIS APPLICATION� THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I Am THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER I A,lREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
CALL
ml�.ppfl..I.. 1� t. p—II.M11 Ngr�d by .
TION; AND IN 0 NG THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATICIN OF THE U W"t DE OF THE STAT F WASHINGTON RELATING TO
WORKMEWS COMPENSAT;"SU�NCE AND RCW 16,27.
FOR INSPECTION
BUIdI.It 0111�1.t., hl�fh., O.puty: rd F.—r. p.1d, .�d
Ipt Is acknoledged in space p-Ided.
SIGNATURE IOVYVWO GtEN�� DATE SIGNED
25)
OFFICIALS SIGNATURE DATE
771-0220
RELEASED BY I DATE
ATTENTION
E)Cr 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE - YELLOW, INSPECTO
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OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .................
FOUNDATION:
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Pier/Porch
Retaining VVell . .............
Slab'Insulation
PLUMBING:
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HEATING:
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Equipment ...............
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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
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ...............