20020895.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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NUMBER
JOB 111TEIPT
ADDRESS 6_\,_
FLAT NAMEISUBDIVISION NO, I LOT 110, LID NO,
LID FEE I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP T ... mm'.
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EXISTING — PROPOSED —
REQUIRED DEDICATION— FT
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NAME CUL
EN.I.EEMN. F... -1 DATE
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CITY ZIP LEPHONE
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RATION DATE
STATE LICENSE NUMBER EXPI K
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urnafficated am. C NO S
PROPERTY TAX AC 0 NIT PARCEL NO,
ISEPA REVIEW SIGNN AR. A
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LOT COVERAGE REQUIRED SETBACKS (FT. BACKS (Fr.)
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COMPLIA CE OR
0 ADDITION COMMERCIAL CHANGEOFUSE
REMODEL MULTIFAMILY SIGN
k PLANNING REVIEWED DATE
REPAIR GRADING CY.E 's CC
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REMARKS
OTHER
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE %
City Surcharge
PLAN CH 'ESTED DATE
P LA N C H E C K IN 0
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
T Ps R MIT A U T H 0 R 0 L Y
P E
E: BE DONE ON PRIVATE PROPERInt ONLY. ANY CONSTRUCTION ON THE PUBUC
E V A P
0 0 N R TE SO
Grading
N DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS 'EES. ETC.) WILL REQUIRE
EV
N U RO 6 A
0 Rc S
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S EPARATE PER M;SSIORN'
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Engr. Review
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PERMIT APPLICAD N: ISO DAYS
P
PERMIT LIM r. I YEAA - PROVIDED WORK IS STARTED WITHIN I&D DAYS
P. IT M I 'BAD F R
Engr. Inspection
F F I. K
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
E E A K
NT. ON BEHALF F His OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
P PL 'C - ENA
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Fire Revim Plan Chk. Deposit
IN INTE E T, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
I. IN TERES AGREES To INGEM
a EDMONZSVVASHINGTON� ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
EDMOND. WASHINGTON IT. or
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Fire Inspection Receipt
ALL CLAJMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECRY OR INDIRECTLY
ALL CW.. FOR DAMAGES OF W"
FROM THE ISSUANCE Of THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
,a.. THE ISSUANCE OF THIS P
DEEMED TO MODIFY. WAIVE OR REOU E ANY REQUIREMENT OF ANY CITY ORDINA CE
DEEMED To ..I- WAVE OR -
Landscape Insp. Total Amt. Due
75
TY CE PROVISION.-
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINAN
Receipt #
Recording Fee
THAT I HAVE DEAD THIS APPLICATION; THAT THE INFORMATION
HERE_ ACKNOWLE 'T
APPLICATION APPROVAL
'"""By A H AGENT OF
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VEN 'a C .. E.T . A D THAT I AM WN' OR TH DUI.Y AUTHORIZE
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A E T W1 11 AN' TATE LAWS REGULATING CONSTRUC-
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ThIsappli,
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A TH ' i FflZED TH NO PERSON WILL BE EMPLOYED
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- R OF WASHINGTON RELATING TO
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OWNER E SIGNED
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12AN
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771-0220 -RELEASED _TDATE�
BY
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-
ORIG NAI. - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
PINK - OWNER G W - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall_ ..........................
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Pier/Porch . ...........
Slab Insulation
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PLUMBING:
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ndirground .............
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Rough -in ............
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Commercial Final
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HEATING:
Gas Test ....................
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Gas Piping ............
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Equipment
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Commercial Final
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EXTERIOR SHEATHING
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NAILING .................
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FRAMING ................
FIRST FLOOR FRAMING
INSULATION ..........
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Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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