20020696.pdfLPERMIT EXPIRES
CITY OF EDMONDS
USE
ZONE PERMIT
NUMBERNMV -06
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
OWNER
ADDRESS
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NAMEINAME OF BUSINESS
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PLAT NAMEISUBDIVISION No. LOT NO I
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REMARKS
CITY ZIP [TELEPHONE
OWNERICONTRACTOn RESPONSIBLE FOR EROSION CONTROL/
NAME ICIL I
ADDRESS
CITY TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
NEW RESIDENTIAL
RESIDENTIAL
PLUMBING/MECH
ADDITION
COMMERCIAL
COMPLIA CE OR
CHANGEOFUSE
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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7HEAT
Building Permit
DATE
Plumbing
THIS PERMIT AUTHORIZER ONLY THE AORK NOTED. THIS
PERMIT COVERS WORK TO
IT
Mechanical
t BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTIR CTIOANONTHEPUOLIC
,
Grading
DOMAIN (CURBS' SIDSWALKS'D
3 SEM RIVEWAYS MARQUEES, ETC.) WILL REQUIRE
t: MTEPERM;SSION.
2
PER ITAPPUCATION: INDAYS
Engr. ReView
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Mr. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chi Deposit
;APPLIC
N INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Z EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receiptfl
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE I SUANCC OF THIS PERMIT ISSUANCE F THIS PERMIT SHALL NOT BE
0 EMED TO MODIFY. WAIVE OR RED CE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
I TOGIAMI.Duis
a NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
Recording Fee
THERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE IS CORRECT, AND THAT I AM THE OWNER� OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL SE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
an Rang Officad or h1alhal Do Iny: and FOOS Od paid, and
FOR INSPECTION 4
WORKMEWS COMPENSATION INSURANCE AND RCVV 1827�
SI�NATURE
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(425
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on)/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL . FILE - YELLOW . INS , PECT&A
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER - GOLD -ASSCSSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall......................
Pier/Porch . .............
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
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 ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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