20020562.pdfDATE RECEIVER
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PERMITEXPIRES
USE PERMIT
CITY OF EDMONDS
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
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REMARKS
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HEIGHT
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REQUIRED SETBACKS (FT) PROPOSED
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(TYPE OF USE, BUSINESS A ACTIVITY) EXPLAIN:
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CHECKED
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DESCRIBE WORK TO BE DONE
REMARKS
..Pqq uNqPFCTIONS PER UBC 10S/FINAL INSPECTION Beat
Description
FEE
Descript:
FEE
Plan Check
State Surct g.
SOURCE
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
I Mechanical
T ... F."MITAUTHORIZ15 ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE 0. PRIVATE PROPERTY ONVI, ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (C , SIDEWALKS, DRIVEWAYS, MAR U ES. ETC.) WILL REQUIRE
'CURNES. 0 E
SEPAREATEPEREMISSIOLL
PER REAPPLICATION: INDAYS
Mr
PERMIT LIMIT. I YEAR ' PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr, Inspection
PlanChk.Deposit
*APILICAW, ON BEHALF 011111 OR HER SPOUSE, HEIRI, ASSIGNS AND SUCCESORS
IN INTE A EST, AGREES TO INDEMNIFN. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES 0 WHATEVER NATURE, ARISING DIRECRY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire inspection
Landscapelnsp,
Recording Fee
Receipt #
Total Amt. Due
Receipt N
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT,TH INFORMATION
GIVEN CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTi ORIZED AGENT OF
IS
THE OWNER, I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONV`LC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA80R ODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN':=14SATION INSURANCE AND RCW 18.27
APPLICATION APPROVAL
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CALL d1.9 oftLEI.' hil I- Xp"s ry
LE'jIThJ1aPPItI00$1 - -
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FOR INSPECTION
G UFF� �All
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fi� OR AGENT) DATE SIGNED
1-yM- 2 71,� 7 � "' �" ,
(425)
771-0220 . NLEA.S
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR,A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED UBC SECTION 09
04/02 PRESS HARD -YOU ARE MAKING
ORGINAL-FILE - YELLOW -INSPECTOR
P�NK-OWNER . GOLD -ASSESSOR
5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall ..............
Pier/Porch .................
Retaining Wall ......... .
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Slab Insulation ..........
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PLUMBING:
Underground .............
Rough -In ...................
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Ma
0
C mercial Final
0
HEATING:
X M
'deg-Tsat ........................ .
0
'Gas
Piping .............
Equipment .................
Commercial Final
0 -n
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EXTER OR SHEATHING
I
M M
NAILING ..................
0,—
FRAMING........................
0
C
FIRST FLOOR FRAMING
C4
Q 0
INSULATION ...................
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................