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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN JCUREIS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
PERMIT ILIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTI Y OH INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF T"!' , it!RMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION!
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION Qf-�LABOFI CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S.�NSMON INSURANCE AND RCW 18.27.
DATE SIGNED
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REMARKS
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REG-W 9
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
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Total Amt. Due
Recording Fee
Receipt #
4Q
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
APPLICATION APPROVAL
This application is not a permit until Signed by the
Building Official or his/her Deputy: and Foos are paid, and
receipt Is acknowledged in space provided.
OFF 3 ATURE DATE
�eLq 10-3
R E �_Dbf DATE
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 - IN&PECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER 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..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
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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CITYOFEDMONDS
CONSTRUCTION PERMIT APPLICATION,,,,
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DEMOLISH
TANK
GARAGE
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CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER.
NUMBER OF
OF
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STORIES
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DESCRIBE WORK TO BE DONE
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PLAT NAME/SUBDIVISION NO. 7
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LID NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING - PROPOSED-
Street Use Permit Req'd
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Sidewalk Required! [3
REQUIRED DEDICATION- FT
Underground
wiring required
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
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1:1 PLUMBING / MECH
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
P90POSED SET4kACKS (Fr.)
7ONT LJR SIDE REAR
PARKING
REO'D I PROVIDED
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Description FEE Description FEE
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HEAT SOURCE
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LOT SLOPE %
Building Permit
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City Surcharge
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PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
2 rC.) WILL REQUIRE
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, E
SEPARATE PERMISSION.
r. Review
PERMIT APPILICAT6i. &DAiSL'4
IL PERMIT ILIMM 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 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S AB TO ENFORCE ANY ORDINANCE PROVISION.-
1
zi 'jl."
Recording Fee
Receipt #
1 HEREBY 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
Bull ding Official or his/her Deputy: and Fees are paid, an d
IN VIOLATION OfTtt&,LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN'!,pelgIPIINSA�ON INSURANCE AND RCW 18.27.
OFFI rURE DATE
SIGNATU W AGENT)
DATE SIGNED
771-0220
RgE DATE
AYANTION
M 1333
IT IS UNLAWFUL TO USE OR OCC IJPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW 'PECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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