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CONSTRUCTION PERMIT APPLICATION �AOODRESS 22�Z
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Description
FEE
Description
FEE
Plan Check
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Building Permit
City Surcharge
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THIS PERMIT AUTHORIZES ONLY THE WO K NOTED. THIS PERMIT COVERS WORK TO
1: BI 10111 ON P1111 '"OPERITY 0"I ANY CO"Se"1111" IN THE PUBLIC
Grading
OMAIH (CURBS, SIDEWALKS, DRIVEWAYS ETC.) WILL REQUIRE
QNU'ES'
tt SEPARAT E P ERMISUS41
Engr. REVIEW,
PE MITAPPLICATION: INDAYS
PERMIT LIMTE I YEAR - PROW ED WORK 15 STARTED WITHIN 'Zo DAYS
Engr. Inspection
SEC 13 ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICA ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PlanChk.Depo
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON ' ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY WAII E OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC
Landsc pe Insp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILI TY TO ENFORCE ANY ORDINANCE PROVISION�
—_
Recording Fee
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
APPLICATION
A
GIVE IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
T E OWNER, I AGREE TO COMPLY WITH CI AND STATE LAWS REGULATING CONSTRUC�
CALL
This application Is not a remit
TION; AND IN DOING THE WORK AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN OLAT15�=,H LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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VVV V 0 LAT`�y
FOR INSPECTION
Sodding 01ficial or his/her Derenty:
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WeWeWeWe R.E.. ATI.N INSURANCE AN. FICW I&t,l.
W.R.Jtls.a�y
OF ALS
SIGNATUr(IOW016A OR AGE
(425)
GNATUR
11 ' 6
UUQ(t, 'I
771-0220
RELEASED 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- ORIGMAL.r4j,E � YELLOW-INGPECTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK.
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 ...........
Slab insulation .......... .
PLUMBING:
M
underground .............
C
M 0
0
0
Rough -in ..� ................
C
Commercial Final
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HEATING:
C
Gas Test ............
Gas Rping .................
0 n
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Equipment .................
Commercial.Final
mT
ATH
EXTERIOR SHE ING
0
0 Fn
NAILING ..........................
C 0
C CA
M
FRAMING ....................
0
Z
FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
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Wall Insulation ...........
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Ceiling Insulation
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SHEETROCK NAILING
0
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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