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[PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP al�anc_
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EXISTING — PROPOSED—
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REQUIRED DEDICATION—
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NAME
METER SIZE I LINE SIZE
1 110, OF FIXTURES PAY REQUIRED
YEE 13 NO C3 3
ADDRESS
REMARKS
CITY ZIP ITELEPHONE
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS
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PROPERTY TAX ACCOUNT PARCEL NO.
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SIGN AREA
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US SIDE REAR
171 ADDITION
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HANDS OF USE
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
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cyca PENCE
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REMARKS
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REMARKS
PROGRESS INSPECTIONS PER UBC 100IFINAL INSPECTION REDID
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Description
FEE
Description
FEE
State Surcharge
LOT SLOPE %
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City Surcharge
PLAN CHECK N]�� VESTED DATE
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Mechanical
THIS PERMIT AUYHOAIZES IRLYTHEWORKNOTED.THIS PERMIT COVERS WORK TO
t:
2 BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
:I DOMAIN JCURIRS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPAMTEPERMiSSION,
Engr. Review
PE ITAPPLICATION: IBODAYS
PERMITLIMIDIVEARRIPROVID D WORK 15 STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANIL ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDIVIOND1,1NAIHINGTON, ITIOIIICIAIS*6"PIOYIII,ANIIAGEIITIIRQM ANYANG
A L CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECI LY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT "A
M A E
S OR I ,
DEEMEDTOMODI WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANOEE
FY T'
Landscapelnsp.
Total Amt. Due
0 PROVISION
NOR LIMIT IN ANY WAY THE CHYS ABILITY TO ENFORCE ANY ORDINANCE PA.VSON..
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Recording Fee
Receipt #
ILLIL)L
IEUEREHY ACKNOWLFDQE THAT I HAVE READ THIS APPLICATION;77A
T T 'CAM He.
IN A
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUrHOS EDAGENTOF
,
APPLICATION APPROVAL
THEOWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Official ., Plathe, Gainey; and Face aP, paid, and
FOR INSPECTION n.a.dd Is acknowledged in Speed rewided,
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
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Ed N UBE (OWNER 0 G N
(425)
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771-0220
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7FTENT71A lj
AELFISEW DATE
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UN��WFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
11 INS BEEN MADE AND APPROVAL OR A CERTIFI-
l,_dA,GNAL.FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
P,N1Kt.0WNEn GOLD -ASSESSOR
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
PlerlPorch ...............
Z,
0
Retaining Wall
4
Slab Insulation
PLUMBING:
Underground ..........
M
-,In ...............
MRough
Commercial Final
HEATING:
M
M
Gas Test ....................
C Z
Gas Piping
0J
Equipment
On
Commercial Final
In M
EXTERIOR SHEATHING
NAILING ..........................
0
FRAMING- ......................
M 0
FIRST FL60R FRAMING
INSULATION ...................
Floor insulation
Wall Insulation
z
ceiling Insulation
0)
SHEETROCK NAILING
z
0
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .............