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DATE RECEIVED
PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS
JOB SUITE/APT #
CONSTRUCTION PERMIT APPLICATION ADDRESS 6
OWNER NAMEINAME OF BUSINESS I 1 -1--/ r ("-'b or
4, 1 /. 7- 4-il- PLAT NAMEISUBDIVISION NO, LOT No LID NO.
U MAILING ADDRESS LID FEE $
IESCP APPIO-Od 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw permit Required 13
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�re�t Seeet Use Permit Hoq'd 0
CITY EXISTING — PROPOSED inspection Acquired [3
ZIP TELEPHONE SeJoAalk Rflqkj1f0d E3
REQUIRED DEDICATION— FT Undergroend
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 15
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REMARKS
PROGRESS INSPECTIONS PER UBC
1081FINAL INSPECTION REQ'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
ED MATE li_A�W Base Fee
PLAN CHECK NO: Z-2- Plumbing
I-- Mechanical
THIS PERMIT AUTHORIZES ONLY THE W1 117 COVERSwonKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Cr PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review /DL.) Plan Chk. Deposit
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Uj IN INTERE�T, 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 It
tr OR INDIREC I I-Y
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC FLY
* FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM11 SHALL NOT BE Landscape Insp. Total Amt. Due
* DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T14E INFORMATION APPLICATION APPROVAL
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 CONSTRUC- CALL This application is not a perind untilsigned by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Depulyi anri Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowILdged in space provided.
WORKMEN'S COMPENSAT URANCE AND RCW 18.27. OFFIGIAkS__!�G I F DATF
SIGNATURE (OWNER 0 AGENT) DATE SIGNED (425) clee�
F/V i
hilt./ 771-0220 FIFI�'Jbt-D BY DATE I
ATTENTION EXT 13033 1 / i
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L -77—
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL Oil A CERTIFI- ORIGINAL FILE YELLOW - INSPeCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 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 ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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