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0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required C3
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CITY ONE EXISTING — PROPOSED inspection Required E3
Sidewalk Required
REQUIRED DEDICATION-- IFT underground
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
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 VIOILATlg�!.�IE LABOR C9PE)OF THE STATE OF WASHINGTON RELATING TO
WORKMEWS COMPENSATION INSORANCE AND RCW 18.27.
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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SPECIAL INSPECTION AREA LOAD
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D FS
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
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Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
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Plan Chk. Deposit
Fire Inspection
Receipt #
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Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a pernnit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
O)FFICIAl.9 SIGNATU�F DATE
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RELEASED 13Y DATE
ATTENTIOW Z E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
4 141-NALIFIL YELLOW - INS ECTOR
FANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - �'VtEqR GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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DESCRIPTION OF WORK TO BE INSPECTED
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DEC 2 2 20N
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PERMIT COUNTEr,
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING: =n-
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Underground ............. x
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Rough -In ................... M
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Commercial Final ...... 0 C:
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HEATING: M Z
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Gas Test .................... C: _Z
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EXTERIOR SHEATHING a
NAILING .......................... 0
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FRAMING ........................ 9 C/)
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FIRST FLOOR FRAMING ... Z
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
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SPECIAL INSPECTION ... F)
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. 7-
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