20021004.pdfDATE RECIIT
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMITEXPIRES
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PERMIT
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NUMBER
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PIAT NAME]SUBDIVISION
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REMARKS
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RESPONSIBLE FOR EROSION DONOR )UDRAINAGE
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(TYPE OF USE, USIV rVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
EMARKS
R PROGRESS INSPECTIONS PER UBC 10S/FINAL INSPECTION REaO
$
Description
FEE
Description —
FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE %
Building Permit
city Surcharge
PLAN CHECK NO:,2 STED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT D.E. WORK 10
BE DONE ON PRIVATE PROPEFM ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
a RE
DOMABN (CURDS, SIDEWALKS, DRIVEINAYS MARQUEES, ETC.) WILL REQUI
SEPARATEPERMiSSION.
Engr, Review
PE ITAPPUCATION: INDAYS
PEfIMITLIMM.lYFAR.PROVID 0 WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT Fort MORE INFORMATION
IPPLICA". ON DEHALF Or 141S OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS WASHINGTON. ITS OFFICIALS, EMPLOYE S. AND AGENTS FROM ANY AND
ARISING
Fire Inspection
Receipt
ALL CLAIM� FOR DANA ES OF WHATEVER NATURE, DIRECTLY OR INDIRECTLY
FROM T14E 11111,11 OF IS PERMIT I�SIIANCE .1 THIS PERMIT $HALL NOT BE
talAmt Due
DEEMED 16 MODIFY, EVAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp.
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Recording Fee
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1,2
IHERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE IN—--
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSTRUC
` '11Mg.db0h.
THE OWNER. I RCE TO COMPLY WITH CITY AND STATE LAWS REGULATING
AG THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Su"TIA-pp" PEII d F.. — P.Id' OAU
d�Ag O"id.1 r hWh., 0 P y
TIC N; AND IN DOING THE WORK AUTHORIZED
IN VIOLATION OF THE THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION r ... 1pli..�k�—i�dg�,l�,�pa,,POvld0d.
SPUC�GENOF
WORKMEN C Vk
S OMPENSA? IN CE AND How W,27.
?E DATE
-SIGNATURE 0 NEn AGEN
(425)
VIA
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RELEASED BY E
ATTENTION
M 1333 / 11 141�1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
"'F IF,
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
IINKKOWNER 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:
Fooling ..............
Wall.....................
Pier/Porch
Retaining Wall ...........
Stab insulation ..........
PLUMBING:
Underground .............
Rough -in
Commercial Final
HEATING:
Gas Test ....................
Gas Piping
ment
Equip'
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING
FIRST FLOOR FRAMING
INSULATION ...............
Floor Insulation
Wall Insulation ..........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR V"15
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OCCUPANCY ................
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