20040069.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICEN)p NUMBER C9 'T,
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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REPAIR
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GARAGE
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MULTIFAMILY
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GRADING CYDS
TANK
RETAININGWALL
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PERMIT EXPIRES
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PLAT NAME/SUBDIVISION NO LOT NO. LID NO
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WUFF�ICIAC 'STREET MAP 01mil Require
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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.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 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 NAT URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT 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 111E WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIG� 4TU(OWNER O;R� *[-j OAT E ;S ;1N ED -laIll
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PARKING RE PLANNING REVIEWE BY DATE 15
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REO'D I PROVIDED
REMARKS
CHECKED BY I TYPE OF
OCCUPANT
GROUP
OCCUPANT
SPECIAL INSPECTION AREA
REQUIRED [] YES
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D 5
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
Recording Fee
CALL
FOR INSPECTIO
(425) (
771-0220
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FEE Description FEE
State Surcharge
City Surcharge Pc�
Base Fee -4
Plan Chk. Deposit
Receipt #
Total Amt. Due
pt 4
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®Receipt # t."
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APPLICATION APPROVAL
I his application is not a perinit until signed by the
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
7p, ALS SIGN? )AT E
ijURE
ATTENTION &�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW - INSPECTOR
PINK, OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
'FOUNDATION:
Footing ......................
V�e4 ........
Pier/Porch .................
Retaining Wall . ...........
Pjab Insulation ... ...... I
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Undergr66nd
Rough -In ...................
Comm6rclal Final
HEATING:
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Gas Test ....................
Gas Piping .................
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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