20040225.pdfDATE RECEIVED
PERMIT EXLPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
OB suff�E/APT
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OWNER NAME/NAME OF BUSINESS .5
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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ZIP TELEPHONE Sidewalk Required
REQUIRED DEDICATION- FT Undergmund E3
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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STATE LICENSE NUMBER EXPIRATI( DATE CIIEC BY REO'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical Z2( Z
t: 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
011 Fire Review Plan Chk. Deposit
V) 'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
w IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 0
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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C3 Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I Recording Fee Receipt # 12' S�/
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAI ION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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 Building Olficial or his/her Deputy: and Fees are Paid. and
IN VIOLATIONQF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S C#PENSATIO NCE A�p RCW 18.27.
OFFI IA1 IGNATURE
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TURErNER 0: DATE SIGNED (425)
/V, 771-0220 //q_`EASED BY DATE
�T_TEOTION EXT 1333
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 INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PiNK-OWNER - GOLD-ASSr-SSOR
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......... ..............
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Retaining Wall
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Slab Insulation ..........
81 Cn
CD PLUMBING:
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HEATI
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Gat, Piping ..................
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VoZ fc, Equipment ....... I ..........
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 .................. —I-- Lc-
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