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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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REMARKS
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Description
FEE
DesS Ipllon
FEE
Plan Check
G—IN % LOPE %
HEAT SOURCE Lot SLOPE.
Building Permit
City Surcharge
VEST1D`GkTS
PLAN CHECK NO: E
PlumbIng
Mechanical
THIS PERUMM AWHOR�S ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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Grading
I VEwAYS, MARQUEES, ETC.) WILI. REQUIRE
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PEPUPTAPPUCATION: 1NDAYS
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Engr. Inspection
ASSIGNS -0 SUCCESORS
Fire Review
PIanChk.Depos1I
;"PuCANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS.
N INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY 01
AND AGENTS MOM ANY AND
Fire Inspection
Receipt #
EDMONDS, WASHINGTON' as OFFICIALS. EMPLOYEES,
ALL FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTly 09 INDIRECTLY
CLAIMS
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMENT OF MY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABIUTFY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
Receipt 0
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GWEN IS CORRECT. AND THAT I AM THE OWNER. 09 THE DULY AUTHORIZED AGENT 01
pIIiI.Jg..d by
THE OWNER. I AGREE To PLY WITH CITY AND STATE L.AWS REGULATING CONSTRUG
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EMPLOYED
CALL
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TION, AND IN MING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE
IN VIOLATION STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
CODE OF THE
WORKMENS C���N-E AND — IS
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OWNA DATE
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771-0220 BY/
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR GA(l - FILE y1I
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
P�NK OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Fooling ......................
wall..........................
Pier/Porch .................
Retaining Wall
Slab Insulation, ..........
PLUMBING:
Underground .............
Rough -In ............
Commercial Final
HEATING:
Gas Test ................
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
% Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION JOB
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LOT NO,
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NO. OF FIXTURES
PRV REQUIRED
YES E3 NO 13
ADDRESS
REMARKS
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CITY ZIP
ITELEPHO11
NAME
ENGINEERING REVIEWED BY DATE
ADDRES�
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FIRE REVIEWED By DATE
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STATE LICENSE NUMBER EXPIRATION DATE
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COMPLETE ExrMPT
SIGN AREA
A� OWED PROPOSED ALLOWED
HEIGHT
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COMPLIANC opt
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REMARKS
..nrAr.qr INSPECTIONS PER UBC 1081FINAL INSPECTION REO`D
DESCRIBE WORK TO BE DONE
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ISIS liption
FEE
Description
FEE
heck
State Surchwge
G�NG I LOT SLOMM-
g Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
/�q
Mechanical
TH18 I, AuTH EMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I-
BE DONE ATE PROPERTY ONIX ANy COHSTRUCFION ON THE PUBLIC
2,ad g
007H In SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) VAILL REQUIRE
SEPARATEPERM;SSION.
Eng,�n�.,.
peRMITAPPLICATION, JWDAYS
PERU" LIMM I YEAR - PROVIDED WORK IS STARTED *1171 N DAYS
Engr. Inspection
NIBS
SEE MCK OF PINK PERMIT MR MORE INFORMAT110
Plan Chk- DePo�
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND 110011011
TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
ire Review
IN INTEREST, AGREES
EDMONDS. W"HINGTON, ITS OMCIX.S, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt
�L CLAIMS FO DAMAGES OF WHATEVER NATURE. APUSING DIRECTLY �=iNP)ROECTBLY
R 8 LIN T E,
OF THIS P
Total Amt. Due
FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT O'ERM11 BY ORDINANCE
ndscape Insp.
NORUMnINANYWAYT E CITYSAB1U`TYTO ENFORCE ANY.ORADNINYACNCE PROVISION'
Recording Foe
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT'THE INFORMATION
APPLICATION APPROVALf
GIVEN 0 CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTI ORIZED AGENT OF
�,,W WOW by Me
THE OWNE . I AGREE TO COMPLY WTTH CITY AND STATE LAWS REGULATING CONSTRUC
R
CALL
S.X..
dIAQ ogiel 0, Ns�ej Depbry: end Fee. We Paid,
TION; AND IN DOING THE WORK AUTHORIZED TIIEREITY NO PERSON WILL BE EMPILOYED
IN VIOLATIO HINGTON RELATING TO
FOR INSPECTION
WORKMEN`6
OFF�A GMT DATE
DATE IIGNID
10-2-
(425)
11$1�L
1 771-0220
RELEASE By T
ATTENTION
EXT 1333
IT IS NLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
—A�
J�L INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIr
FiNj
-I-
0. GI - FILE YELLOW INSP
CATE OF OCCUPANCY HAS BEEN G RANTED. UBC SECTION 109
P�N� OWNER COLD.ASSESSOO
ACCOLINTING
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