20040778.pdfDATE RECEIVED
[PERMIT EXPIRES
USF PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB HESS TE/APT#
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STATE LICENSE NUMBER
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EXPIRATION DATE
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MULTIFAMILY
REPAIR
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RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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BY CITY INSPECTOR
FIRE REVIrWEf?AT1bAV1T3 =1!1- 1101 DATE
BE ACCEPTED
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REOO POSTED
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PLAW CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Let PERMIT APPLICATION: 11110 DAYS
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
('An 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
LU
_j IN INIFRESI, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMIESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL C1 AIMS FOR DAMAGES OF WHAT EVER NATURE, ARISING DIRECTLY Oil INDIRFCIIY
FROM IHE ISSUANCE OF [HIS PERMIr. ISSUANCE OF ]HIS PERMIT SHAIL NOT BE
DFEMEi) To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NOR I IMIT IN ANY WAY THE CITYS 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 WIT IT CITY AND STATE LAWS REGULATING CONSTRUC
I ION, 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 COMPENSATION INSURANCE AND RCW 18 27.
SIGNATQM (OWNER OFRAqENT).) I DA11 E S)GNED .4
VALUATION
Description
FEE Description
State Surcharge
City Surcharge
2 lBase Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
I Receipt 0 1,20 (1" Z/
APPLICATION APPROVAL'
I Ins application is not a PCIML Until signed by tire
Building Official or Iiisfhet Deputy. and Fees are paid, and
receipt is acknowledged in space provided
qjAf) SIGNATU/,�. / D
EASE[) 13Y DATE/
ATtE�TION L., 1*711_6�Ll EX7 1333
ir is UNLAWFUL TO USE OR OCCUPY A BUILDINY 11 STRUCTURE �NTIL I I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OHIGINAL FILE YELI-CW-INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK OWNER GOLD, AS'iESSOR
0903 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(4205)
771-0220
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INSPECTOR DATE APPROVED
SETBACKS .......................
FOUNDATION:'
Footing .......................
Wall ..........................
..........
hirig Wall . ........... ;'.
Retai'
SIab Insulati&n .............
PLUMBIN'di
Underg�round ..............
Rougfi-In ....................
Commerci6l Final
HEATING:
GasTest .................... .... .
Gas Piping ...........
Equipment ................. 417 7 - t-4L
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ...... ....... .. V.
FIRST FLOOR FR4MINO...,
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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, nionii)son, a twiporary colitl1ict
inspCCtol, for thc City.
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