20050061.pdfDATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DATE D-b VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
REQ*D COMPLETED EXEMPT
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PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
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( X FT.) REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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f Uk) 6101 Q Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DAT . E Building Permit City Surcharge
PLAN&tHECK NO: 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 PUBIC Grading
IE DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
r PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 119.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
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 IReceipt #
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE T
0 NCE Landscapelnsp. Total Amt. Due
j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINA
0 DINANCE PROVISION.-
x I NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY OR Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APP I ATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signod by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_ CALL Building Official or his/her Deputy: and Foes are paid, atiLl
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED rece,pt is acknowledged in space provided
IN VIOLATION OF THE LABqRqq_UE_QE_THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WO sA��RANCE ANDICW 18:27. OFFICI N�SIGN U DATE
DATE/SIGNIE
GNATURE (OW;E?P (425)
(16, N E J& VEN T),,: L
7, 771-0220 PRELEASE-Dr6y D E
EN-(1ON'7_ EXT. 1333
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IT IS UNLAW L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC1110 if IRC110. PINK -OWNER GOLD - ASSESSOR
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RECUR OF INS11-r— I lum,
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall. ..........................
Pier/,Porch ...............
Retaining Wall ............
Slab Insulation ..........
PLUMBING:
Undbrgi6un .............
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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