20040310.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OF BUSINESS
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STATE LICENSE NUMBER EXP
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NUMBER
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NUMBER OF
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DESCRIBE WORK TO BE DONE
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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 (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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-.1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcri.y OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1HIS PERMIT SHALL N01 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR Limi r IN ANY WAY THE CI FY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION
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PERMIT EXPIRES
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ADDRESS
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NAME/SUBDIVISION NO LOT NO. LID NO
I LID FEE $
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REMARKS
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of whet1her the water syst6m
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REMARKS
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OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ'D
VALUATION
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due C,
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT DIE INFORMATION I— L
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER I AGREE rO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC I his application is riot a perinit until signed by the
riON; AND IN DOING 111E WORK AUTIIOR17ED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Depuly:and Fees are paid, and
IN VIOLATION OF THE LABPRZODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENS�AJ,16N INSUR� . NCE AND RCW IL1,27.
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OFFPAt 3NA DATE
SIGNAfUnE (OwNER(Oij AGENT) E S)GNED
7
(425)
MMOMENNO� mmmou�- 771-0220 RFI FASE[T;BY DATE�'
ATTENTION E)ff 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 - ASSESSOR
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES
FEE
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ...................
Retaining Wall
Slab Insulation ....
PLUMBING:
Underground ..............
Rough -In ...................
Commercial Final ......
HEATING:
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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