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DATE RECEIVED
F_� ERMIT EXPIRES
CITY OF EDMONDS
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Description
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Description
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HEAT SOURCE _T GLAZING % LOT SLOPE %
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PLAN CHEC:M,',,,, VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
23 BOMAAN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
k: SEPARATE PERMISSION. Engr. Review
15 PFRMITAPPUCATION: ISO DAYS
LIMM I VEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAK 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
x EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt N
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. I Total Amt. Duel /z
Ix 01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Recording Fee Receipt # L'2
1 HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space provided.
WORKMEN'S CO)PPENSATION INffANCE AND RCW 18.27.
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RECORD OF INSPECTIONS
INSPECTOR DATE.APPROVED
SETBACKS .....................
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Footing......................
Wall.......... I ............
Pier/Porch .... ............
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:Real ing Wall,.
Sl�b,in.siulatio.n ..........
PLUMBING:
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commercial Final ......
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Gas. Piping ................
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EXTERIOR SHEATHING
NAILING .........................
FRAMING . .........................
FIRST FLOOR FRAMING.,:.'
INSULATION . ....................
Floor Insulation .........
W611 Insulation ............
Ceilin g Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NPf1NAME OFNINESP
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MAILING ADDRESS
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JOB SUITE/APT#
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PLAT NAME/SUBDIVISION NO. LOT NO. LIDP.
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TESCP Approved
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP RW P6rmtt Required
street Ilse freffnIt Req'd
Inspectio Required
EXISTING Sidewalk"Required
Underground
REQUIRED DEDICAT Wiring required 13
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
ADDRESS
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
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NUMBER
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LOAD
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NUMBER.
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REMARKS
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORUMB ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
X
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
�Epnftvlew
PERMITAPPLI&FfOIN:VW�A4, I
IL
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIF`Y DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Landscapelnsp.
Total Amt. Due
Id5
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Receipt #
Recording Fee
1221,444
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
a
APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit unfit signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Foos are paid, and
receipt Is acknoydedgod In space provided,
WORKMEN'S CO)fPENSATION INJ E AND RCW 18.27.
Offl LS QdATU TE
SIGNATUR
DATE OGNED
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-wmr..
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Vs �I' V.A 1_:7
771-0220
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RiLE991) BY v A
ATTEW16N
EXT 13313
/7'
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 - IWSPECIOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSESSbR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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