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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO. I
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NEW RESIDENTIAL PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
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REPAIR GRADING FENCE
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VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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 CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S SATION INSURANCE AND RCW/18.27.
SIGNA�T,UR (OWNER 0' AGEI�M,
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PERMIT EXPIRES
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N U M B E
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NO. LOT NO.
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iXISTING — PROPOSED
4EQUIRED DEDICATION-- FT
MEIER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
!—USCP Approved
RW Piltmil Required
Street Use Ponnit Roq'd
Inspection Required
Sidewalk Raq,jlred
Underground
PRV REQUIRED
YES [1 NO'13
EMARKS
,WN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
'4GINEERING REVIEWED BY DATE
IRE REVIEWED BY DATE
VARIANCE OR CU
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DATE
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OCCUPANT
GROUP
OCCUPANT
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EMARKS (9
ROGRESS INSPECTIONS PER UBC 108/IBC109/lRC109 FINAL INSPECTIONfREWD] z
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE I Description I FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
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APPLICATION APPROVANC
his application is not a permit until signed by the
Building 011icial or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR oCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
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 .................
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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