20040260.pdfE RECEIVED
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CONSTRUCTION PERMIT APPLICATION ADDRESS
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PERMIT EXPIRES ----
PERMIT
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OWNER NAMEINAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT/16, LID NO.
cc MAILING ADDRESS LID FEE $
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z PUBLIC RIGHT.9f WAY PER OFFICIAL STREET MAP Rw Permit Required C3
0 Street Use Partnit Req'd E3
/'S inspection Require
CITY ZIP TELEPHONE EXISTING PROPOSED rid 13,
Sidewalk Require [3
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REQUIRED DEDICATION— FT Witing required
NAME METER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
YES NO 13
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE 5
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLEI It: EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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DESCRIBE WORK TO BE DONE In 171
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee
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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 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc:
W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) '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
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION " . .1 -14
Recording Fee Receipt #
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 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 OfliCial or his/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WAS14INGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPqNSATION INSURANCE AND RCW 18.27. URE DATE
OFFICIA S1
ATURE tow ER ,AGENT) DATE/IGNED
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771-0220 RgIJEASED (�,X rTE
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 IN. TnM
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing ......................
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Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground.............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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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