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DATE RECEIVED
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LPERMIT EXPIRES W_Z11-1111111111
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAM E/S UB DIVISION NO LOT NO,
LID NO.
LID FEE S
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MAILING ADDREMS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved [3
RW Permit Required 13
EXISTING — PROPOSED
Street Use Permit Fleq'd E3
inspection Required 13
CITY P
TELEPHONE
Sidewalk Required 13
yr
REQUIRED DEDICATION— IFT
Underground
wiring required 13
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
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ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE
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SIGN AREA
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HEIGHT
ALLOWED PROPOSED
PROPERTYTAX XtC6UNT PARCEL NO.
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PLUMBING / MECH
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PROPOSED SETBACKS (FT)
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ALLOWED PROPOSED
FRONT SIDE REAR
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE
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MULTIFAMILY
OF USE
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(TYPE OF USE, Bust OR ACTIVITY) EXPLAIN:
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OCCUPANT
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION RECI'D
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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Building Permit
City Surcharge
,4,44,
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160DAYS
IL PERMIT LIMIT I 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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION - receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
Owil LS SIMATURE DATE
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SIGN�JWE (OWNER 0 EN DATE SIG
(42,15)
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771-0220
O/ATE
RELEASE6 By
ATTENTION
EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/lBC110/lRC110.
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 ................. --------------
Retaining Wall ........... ----------
---------- -
Slab Insulation ..........
PLUMBING,
----------- -
Underground ............. -----------
Rough-In ...................
Commercial Final ...... — -----------
HEATING:
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Gas Test .............. 4,
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 k-.
OCCUPANCY ..................
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