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PERMIT EXPIRES x
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
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OWNER NAMEINAME OF BUSINESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REQUIRED DEDICATION— FT
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TESCP Approved C3
AW Permit Required
Street Use Permit Roq'd
Inspection Required E3
Sidewalk Required
Underground
Wring required C3
CITY ZIP
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TELEPHONE
12- CC71
NAME
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METER SIZE
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STATE LICENSE NUMBER EXPIRATION DATE
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REMODEL MULTIFAMILY SIGN
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ALLOWED PROPOSED
REQUIRED SETBACKS (FT)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UR SIDE REAR
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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Description
FEE
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Plan Check
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Building Permit
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VESTED DATE
Plumbing
Mechanical
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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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION,
Grading
Engr. Review
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PERMIT APPLICATION: 180'bAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
OAPPLICANT, 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 DIRECTLY OR INDIREC[LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
Fire Review
Plan Chk, Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
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Recording Fee
_tReceipt
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I HEREBY ACKNOWLEDGE THAI I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEI`4— IS CORRECT. AND THAA I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE/OWNER. I AGPEE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN D014G THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN�IOLAJION OF ITHE LABOR CODE OF THE STATE OF WASHINGTON RELAT NG TO
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W RKMEO'S CQMMNSATIOX- INSURANCE AND RCW 18.27.
SI NATY11 (OW OCIET,__� DAT SIGNED
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APPLICATION APPROVAL
This'application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFIql SIGNA77 DATE
(425)
771-0220 'hELE . �SEq By OTE
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ATTENTION\ EXT 1333 )��
I
UPY A BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OQC
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-FILE - YELLOW -INSPECT R
CATE OF OCCUPANCY HAS BEEN FIRANTED, UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
04/02 tD , 09=12112 W A On - Vr)I I A QI= hfi A VlMr. 9 rjr)DIj=Q, GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .......................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retelining, Wall ............
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-Slab Insulation ..........
0
M
1W4, PLUMBING:
Underground .............
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564igh-In ............
M 0
0
Cbmrher6al Final ......
0 C:
HEATING:
X M
MZ
Gas Test .............. I ......
C —Z
Gas Piping .................
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Equipment .................
0 n
Commercial Final .......
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EXTERIOR SHEATHING
M M
NAILING ..........................
0
0 M
FRAMING ........................
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FIRST FLOOR FRAMING ...
Q 0
Z
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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0
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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