20040558.pdf0
DATE RECEIVED
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I PERMIT EXPIRES
CITY
OF EDMONDS
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PERMIT
N U M B E R
CONSTRUCTION PERMIT APPLICATION
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PUBIJC; RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RVf Permit Paquaeu
0
0
Street use Permit Recd
0
CITY
ZIP TELEPHONE
EXISTING — PROPOSED
inspection Required
Sidewalk Required
0
0
REQUIRED DEDICATION—
FT
Underground
Wiring required
0
NAME
METER SIZE LINE SIZE
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F FIXTURES PRV REQUIRED
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ADDRESS
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NAME
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CITY
REMARKS
OWNERY'CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
kL I FIRE REVIEWED BY
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY ..
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APARTMENT
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
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CARPOR1
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBEROF
OF DWELLING
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DESCRIBE WORK TO BE DONE
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PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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DATE
SHORELINE OR ADBk INSPECTION BOND
REQ'D POSTED
0 YES 0 NO I
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PLAN CHECK NO: IVESTED DATE
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: 180 DAYS
LU
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS ANO SUCCF'SOR�
U)
w IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE C11Y OF
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2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FI4C)rll ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING UIFIECTLY OR INDIFIECTLY
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT [;I:
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIRENIFNT OF ANY C11 Y ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILI ly IOENFORCE ANYOHDINANCF P�IOVIS'ION
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 CONSTRUG
1 ION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL FE EMPt OYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHING TON REL ATING TO
WORKMEN'S C5;4VNSATION INSURANCE AND RCW 16.27
NATURE,
�CO W N E- 0 R N G F 6T��/ f)AlF SIGNED
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A17ENTION
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
5/qB
VALUATION I FEE
PLAN CHECK PEE
BUILDING
PLUMBING
,,,ECHANICAl-
GRAOING 91� L
ENG REVIEW FEES
ENG INSPECTION FEE
� ANDSCAPING
INSPI C I ION FEE
RECEIPT
fl�.AN CHl-CK DEPOSIT
0 1 AL Af.iOUN I OLJ L
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�A-'POLICATION APPROVAL
CALL
I tlis jipplicalion is riot jj pi,rmit until siped b� Ine
Bulldling Otficial or h,S,nLr Dap'tily and FeLl afL Cilld, arl(i
FOR INSPECTION
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(425)
771-0220
H4LEASED /[)AT F-
EXT 333
771-0221
ORIGINAL FILE YELLOW INSPECTOR
FAX
PINK -OWNER GOLD -ASSESSOR
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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........................
FIRjj,'jF "', " A)(M44G*,'�V4
. UOOR
IASULATION- x.� .. ....
Floor Insulation ...
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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