20030506.pdfDATE RECEIVED
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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
JOB SUITTIAPTO
ADDRESS
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
CITY
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ENGINEERING REVIEWED By DATE
FIRE REVIEWED ay DATE
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STATE LICENSE NUMBER EXPIRATION
VARIANCE OR CU SHORELINE OR ADSO INSPEC!ION BOND
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COMPLIANCE OR
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REMARKS
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REMARKS
PROGRESS INSPECTIONS PER USC 108/11FINAL INSPECTION REO'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
City Surcharge
Building Permit
PLAN CHECK NO:
lumbing
Mechanical
THIS PERMIT AUTHOPUZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
M OMAJN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC,I WILL REQUIRE
2 D
t: SEPARATEPERMISSION.
RE MIT APPLICATION: 1W DAYS
Engr, Review
PERMIT LIMIT I Y EAR - PROVIDED WORK IS STARTED WITHIN ISO 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 ANYAND
Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 08 INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO M DIFY� WAIVE OB REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Total Amt. Ou
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NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROWSIOW'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE RE D THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT'ANO THAT I AM THE OWNER, On THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
This OPPlIcaft. is six . psr.A.MiI.Ign.d by 0.
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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IT IS UN VVFUL TO Us R OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION S BEEN MADE AND APPROVAL OR A CERTIFI- ORKIWAL-FILE YELLOW -INSPECTOR
CATE OF OCCUPANCY S BEEN GRANTED. UBC SECTION 109
PINK-OWNEn GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .............
FOUNDATION:
Footing ......................
Wall . .........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
INSULATION ...................
Floor Insulation
Wall Insulation ...........
ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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