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CITY OF EDMONDS ZONE ERM T
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CONSTRUCTION PERMIT APPLICATION JOB "I"t"Fr"
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ADDRESS REMARKS
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C OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIBRAINAGE
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STATE UdENSE NUMBER 1�7 DA; CHECKED BY VARIANCE OR CU SHORELINE OR ADS# INSPECTION
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PROPERTY TAX ACCOUNT PARCEL NO, COMPLETE EXEMPT ALLOWED ALLOWED ROROS'o
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NEW 0 RESIDE IAL [I PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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(TYPE OF USE, BUSINE
CHECKED BY CODE OCCUPANT
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DESCRIBE WORK TO BE DONE
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VALUATION $
Description FEE Description FEE
Plan Check
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HEAT SOURCE GLAZING % LOT SLOPE % Building
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PLAN CHECK NO: DATE Plumbing 0
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Mechanical
THIS PEFIMR`AUYHORIZES ONLY 7HF WORK NOTED. THIS PERMIT COVERS WORK TO
1: SEDONEONPRIVATEP OPERTY ONLY. ANY CONSTRUCIRON ON THE PUBLIC Grading Recording Be
2
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MAN UEES,ETC.)WILL
1 0 REQUIRE
SEPARATE PERMISSION, Engr. Review City Surcharge
Re MrTAPPLICATION: ISODAYS
PERMIT UNIT. I YEAR- PROIND 0 WORK IS STARTED WITHIN I 'a DAYS Engr.inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
—PUCA , ON BEHALF Or HIS 0111111 1POU11, HEIIS. ASSIGNS AND SuCCIES.RS Traffic Miligalion Plan Chk Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLE) HARMLESS THE CITY OF
WAS.'—... ITS IDITIC-1-S. EMPLOYEES, AN. AGENTS FROM ANY Me Fire Reviow 5,9- Receipt Ill
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTlY OR INDIRECTLY
FROM THE ISSUANCE 01 THIS IERMG. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire inspection 01 TotalAmountDue
DEEMED TO MODIFY WAIVE OR REDUCE OF CITY 4
ANY REQUIREMENT MY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
4THE
Landscapeinsp.1 Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION APPLICATION APP� VAI
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGU ING CONSTRUC. CALL Thiarnpiplic0ce Ja net. parealt.dull eignad by Me
TION; AND J� DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Budding Official or Maurer Barely: and Ras are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION —up, I—kne.l.ugad In.p.o. pld.d.
WOAKMEN'SCOMPENSATIONIN.SURANCE AN ACWHI.27,
_INS F NATU 1 DATE
TURE (OWN 1. (425)
JIINE�
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771-0220 'RE 'DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
7,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI. ORIGINAL -FILE YELL04-INSPE6TOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK -OWNER GOLD -ASSESSOR
laid,
4105
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing
wall � .........................
Pier/Porch .................
Retaining Wall
0
Slab Insulation ..........
0
M
PLUMBING:
Underground .............
C3
M
Rough-ln,�
M
Commercial Final
0
HEATING:
-L M
ITI
10
Gas Test ..........
C
Gas Piping ..............
Equipment
Commercial Final
0-0
EXTERIOR SHEAT HING
MITI
NAILING ..........
a
0
p Fn
FRAMING ........................
C 0)
FIRST FLOOR FRAMING
Q 0
INSULATION ...................
71
Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
0
R1
MISCELLANEOUS ..........
FINAL APPROVAL FOR
t OCCUPANCY ..................
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