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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE PERMIT �
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PLAT NAMEISUBDIVISION NO.
LOT NO,
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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Descrintion
FEE Description FEE
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PLAN CHECK NO:
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Ties AUTHOROES ONLY THE ORKNOTED.THIS
PERMIT COVER WORKTO
1,; BE DONE ON PRIVATE PROPER" ONLY. ANY CONSTFILICTIONIONYHE PUBLIC
Grading
Recording Fee
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3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL E UIRE
SEPANUITEPERMISSPON.
Engr% Review
City Surcharge
PE MITAPPLICATION: IS0.
PERMIT LIMIT. I YEAR - PROVio WORK 15 STARTED WITHIN IN DAYS
Engr. Inspection
State Surcharge
SEE RACK OF PINK PERMIT FOR MORE INFORMATION
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*APPLICANT, ON BEHALF OF H18 OR HER 11OUIE, HEIII, A SIMONS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIF DEFEND AND HOLD
EDMONDS, WASHINGTON� ITS OFFICYA'LS, EMPLOYEES. AND AGENTS FR
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IALL CLAIMS FOR DAMAGES OF WHATEVER, NATURE, ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
SHALL NOT BE
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FROM THE ISSUANCE OF THIS PERMIT. 5SUANCE OF THIS PERMIT
RM`T AN E " PERMIT
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BEL C OF I S
C TY DINANC'
9 SEEMED To Me Fy� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
`R REDUCE ANY REQUIREMENT OF ANY I OR
Fire Inspection
Total Amount D Ue
G E OW"O"i
—S ABILITY To ENFORCE ANY OR 'NANG Ps
0 NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.
Receipt #
, THAT THEM,
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AVE a A P AT
' - EAD THIS P Le
APPLICATION APPROVAL
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GIVEN IS CORRECT, AND THAT I AM THE OWNER, On THE DULY AUTHORIZED AGENT OF
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS FIEGULATIN. C.NSTNUC.
CALL
ThI,INPI1..Iw% le no"' w4ligradbygn,
TION; SQE"E0?NP`LT0RYUEC
. OF Z I It BY 0 Be WILL
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V, ANDIIN DOING THE WORK AUTHORIZED THERERYD.N0 PERSON WILL 0
IN R CODE OF THE STATE OF WASHINGTON RELATING TO
OLAT ON OF THE LAUD
FOR INSPECTION
Bn"ding 0 wh" D`P`Y: and Flo. we paid, and
1-9 r1P;11a`-'�hkir—IwJW1d In eP ... la.�Jdwl-
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WORKMEN`�.�PENSATION INSURANCE AND nCW 18.27.
OFFI� DATE j
SIGNATU:�� I DATE SIGNED
(425)
771-0220
ATT!ENTK)N-"4_--
Off 1333
R'&AtEp BY DATE
11k,111 k;lil�
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-
ORIGINALLFa YELLOW - INSPECIOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD - ASSESSOR
10/01
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
S ETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall
Stab Insulation
171
PLUMBING:
Underground .............
0 M
Rough -In ..........
M a
0
0
Commercial Final
C: ir
HEATING:
h M
10
Gas Test ....................
C
Gas Piping .................
Equipment .................
on "n
Commercial Final
EXTERIOR SHEATHING
171 M
MAILING
0
FRAMING
C to
C CA,
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
SPECIAL INSPECTION
0
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