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PERMIT EXPIRES
CITY OF EDMONDS
USES P ?
ZON ERMIT
NUMBER 0
JOB SUITE/APT#
ADDRESS --I , ,"A .
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF 5SINESS
PLAT NAMEISUBDIVISION NO.
I LOT NO,
LID 110,
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MAILING ADDRESS I
LID FEE S
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REQUIRED DEDICATION— FT
NAME
METER SIZE
LINE SIIE
NO. OF FIXTURES
REQUIRED
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ADDRESS
REMARKS
OWNEFUCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAIUAGE
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STATE LICENSE NUMBER EXPIRATION DATE
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SPECIAL INSPECTION
REQUIRED
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IOS/FINAL INSPECTION REOD
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VISTEO DATE
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Plumbing
THIS PERMIT AUTHORMS ONLY THE WO K NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE LIC
PUB
PUBLIC
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2 VILL
:1 OMUUN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
PERMIT "PLICATION: IWDAYS
PERMIT LIMIc I YsAR � PROVI ED WORK IS STARTED WITHIN Tes DAYS
SEE SACK OF PINK PERMIT FOR MORE INFORMATION
Me chanical
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Grading
Engr. Review
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS A SIGNS AND SUCCESORS Fire Review Plan Chk, Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLDSHARMLESS THE CITY OF
EDMONDEL WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING D RECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT B 71;
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OFANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0. NOR LIMIT IN ANY WAY THE CHNS ABILITY TO ENFORCE ANY ORDINANCE PROWSIOIC'
R cording Fe Receipt #
IHEREBY ACKNOW � Ell GGE ATHA1,LH"AVE READ THIS APPLICATI N; THAT THE INFORMATION APPLICATION APPROVAL
Cc '' , THA
GIVEN IS REC A ID THA AM THE OW ER. OR THE U- AUTH.M= AGENT OF
I E
R I I To C.,
THE OWNE AG �t Ly WITH CITY AND STATE LAWS REGULATING C.N.R.C. Thil applicelion le 1. � pe-11 Moil Moned by Me
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TION; A W I AUTHORI ED THE11BY. NO PERSON WILL 11 CALL Seeding Offl-t-I -1 hWh.1 D.Pery:.M! F .. M. P.Id, eMl
'. BOB OF THE $TAT OF WASHINGTON REI
IN VIC 1BCm COE C ON IPI ie.CI,--IeM;ed M,p.. pre,ld�d.
a URANCE AND ACW 18.27, FOR INSPE TI
WORK.j IT ,
SIGNAT(ft (OWNER 8 E DATE E (425) OFF191-ALS �K)NqURE DATE
(1-1 L1_
7.1-20 RELEASED BY I DATE
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- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall.....................
Pier/Porch .. ...............
Retaining Wall ...........
Slab Insulation
PLUMBING:
M
C
M
0
Underground
-40
0 C
Rough -In ................... .
M
Commercial Final
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HEATING:
Gas Test ..................
Gas Piping
-4
Equipment
M M
Commercial Final
0
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EXTERIOR SHEATHING
C
CA
NAILING . .........................
M 0
FRAMING ..................
FIRST FLOOR FRAMING
INSULATION
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Floor Insulation
Wall Insulation ...........
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Coiling Insulation
0
R11
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
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