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DATE RECEIVED
USE PERMIT
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CITY OF EDMONDS ..�41
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS W
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OWNER NAMEMAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
UM MAILING ADDRESS LID FEE $ E3
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STATE LICENSE NUMBER EXPIRATION DATE I RHYCKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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(TYPE OF USE, BUSINESSQR ACT.IVITY) EXPLAIN:
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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: 180 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 PERMIT 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,"
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 AGRiE 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
WORKMEY'S COMPENSATION INSURANCE AND RCW IB.27.
S, %NATUF� (OW NER OR DATE SIGNED
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SPECIAL INSPECTION. JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS ON REQ'D
[PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECT11
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr, Inspection
FEE Description
State Surcharge
city Surcharge
Base Fee
FEE
Fire Review PlanChk.Deposit
Fire Inspection Receipt # 6 11A �7
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
QEFIWAS SIGN IE DATE
(425) �� X 1
771-022 &ASPE4BY
6ATE
A7TCK1T1n CA 1 110 J
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACEPTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109jIBC110/1RC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
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 .......... -----------
1,
FINAL APPROVAL FOR
OCCUPANCY ..................
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