20040634.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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USE PERMIT
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PLAT NAMEISUBDIVLSION NO
LOT NO.
LID NO
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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NO. OF FIXTURES
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METER SIZE
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LINE SIZE
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REMARKS
OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
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STATE LICENSE NUMBER
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EXPIRATION DATE
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NUMBER NUMBER OF
OF '2' 1 DW
STORIES UNITS
DESCRIBE WORK TO BE DONE
1:1 PLUMBING/MECK
COMPLIANCE OR
CHANGE OF USE
SIGN
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FIRE SPRINKLER
SEPA REVIEW
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D 5
VALUATION
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Description
Description
FEE
Plan Check
jFEE
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State Surcharge
HEAT % LOT SLOPE %
Building Permit
City Surcharge
VESTED DATE
PLAN CHEC!,
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COIER-S WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 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
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt
ALL CLAIMS FOR DAMAGES OF WHATEVER NATU FIE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
CITY ORDINANCE
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Total Amt. Due q
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DEEMED TO MODIFY WAIVE OR REDUCE ANY RE QUIREMENT OF ANY
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01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a pernlit until signed by the
THE
TION; AND IN DOING THE WORK AUTHORIZED TIIEREB)(, NO PERSON WILL BE EMPLOYED
RELATING TO
Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION recLipt is acknowledged in Space Provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 217.
OFFIC)ALS S!�iNATURE AT E
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CNAT'dM" WNER DATE Sl
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ATTENTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
4L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OHIGINA FILE YELLOI PECT R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4
COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation .......... 0
M
PLUMBING:
d .............
Undergroun
3:
M�
Rough -In ................... C
M
0
commercial Final ......
0
C,
HEATING:
M
M z
Gas Test .................... C) —4.
C
Gas Piping .................
Equipment .................
0 -n
Commercial Final ....... -n
EXTERIOR SHEATHING M M
NAILING .......................... 0
0 M
FRAMING ........................ C Cn
Cn
FIRST FLOOR FRAMING ... M 0
Z
-A
INSULATION ...................
Floor Insulation .........
3:
Wall Insulation ........... z
Ceiling Insulation .......
Cn
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................