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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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PERMIT
NUMBER
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ADDRESS Pkie W
PLAT NAMEISUBDIVISI.11 No I LOT No L
L:D NO�
0 FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESC, I
EXISTING — PROPOSED
REQUIRED DEDICATION FT
E NO. OF FIXTURES PAY REQUIRED
YESO No C3
REMARKS
111—TRA—A RESPONSIBLE FOR EROSION CONTAOIJORAINAGE
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ENGINEERING REVIEWS. BY DATE
ADDRESS
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FIRE REVIEWED BY DATE
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REMARKS
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NUMBER , LIM ER OF Ct
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IF 1ALINSPECTION
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LOAD
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NUMBER
JAREA
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DESCRIBE WORK TO BE DONE
RENA KS
INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
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.PROGRESS
Description
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FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE %
LBuildingPermit
City Surcharge
PLAN CHECK FESTED DATE
P'umDng
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
RO ONLY. ANY CONSTRUCTION ON THE PUBLIC
P peff,
Grading
I DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMiSSION.
RE MITAPPLICATION: IN DAYS
Engr, Review
PERMIT LIMIT I YEAR -PROVIDED W RK IS STARTED WITHIN HIODAYS
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 INDEMNIFY, DEFEND AND HOLD HARMLESS T14E CITY OF
a EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt N
ALL CLAIMS FO DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR 11,401RECTLY
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapensp,
T
-:31al Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee
Receipt
ON
I HEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVE IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
CONSTRUC.
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PP
S LAWS
THE OWNER. I AGREE TO COMPLY WITH CITY AND TATE REGULATING
THEREBY NO PEAS A WILL BE EMPLOYED
CALL
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suildlg 011,16'.11 Wh I 1h D� I dF V.
TION; AND IN DOING THE WORK AUTHORIZCO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION Od.d.
WORKMEWS COMPENSATION INSURANCE AND RCVV 18,21,
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fHGNATURE OWN!!j �AGeNlj � SIGNED
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RE trE
AtTPENTION
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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 CEFITIFI-
ORIGINAL FILE YELLOW. NSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOUD-ZSESSOR
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In
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..........
wall.......... I ..............
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Pier/Porch .................
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Retaining Wall
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Slab Insulation
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PLUMBING:
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Underground ............
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Rough -in ..........
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Commercial Final
ID
HEATING:
Gas Test ....................
0 _n
Gas Piping .................
Equipment .................
M M
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Commercial Final
0
6 Fn
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING
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INSULATION ...................
Floor Insulation
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Wall Insulation
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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