20050393.pdfO-EIIICIIVID_
IPERMITEXPIRES�
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C)TY OF EDMONDS
PERMIT
UMBER 0373
CONSTRUCTION PERMIT APPLICATION
JOB I SUITEIAPTA
ADDRESS BfCA 'e MCI,)
OI�NER NAMEINAME OF 13USINESS
PLAT NAMEISUBDIVISION NO.
LOT NO,
110 NO,
LID FEE $
MAILING ADEtESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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REMARKS
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Description
FEE Description FEE
Plan Check
State Surcharge
ESTE.
1_01`11011� VESTED DATE
��URC
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
THI PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY, ANY CCINSTRUCTI.N ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.I WILL REQUIRE
Q SEPARATE PERMISSION.
Engr. RevieW
I Ni
PERMITAPPLICATO :SEE ECOC 19.00,0051A)15)
T PERMIT UMM. SEE ECDC ISAD.005(A)(6)
Engc Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR$
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM AN AND
Fire Inspection
Race. t #
ALL CLAIMS FOR DAMAGES 0 WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
R
PH M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PE MIT SHALL NOT Ub
ORDINANCE
Landscape Insp.
Total AmL Due
DEEMED TO MODIFY, WAIVE OR RED CE ANY REQUIREMENT OF ANY CITY
C NOR LIMIT IN MY WAY THE CITY'S ABILITY TO ENFORCE AN.
Recording Fee
Receipt It
IHEREBYACK OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION AP
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Thi, ppl,-0— MI a P1111t 11 ligIld by th.
THEOWNER. IAGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
CALL
B,ildmg Officill 11 hWh11 DIPIty: 0,d I`— — pd, rd
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, No PERSON WILL BE EMPLOYE
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION .—PON. ledg, 11P1wPM1id1d,
WORKMEN'S I INSURANCE AND RCW 18:27.
OFF JAL SIG E
SIGNATI(I ( WNER GE TL DATE SIGNED
(425)
771-0220
1 1) 12,
RELEASED 8 DATI
P n)--
ATTENTKW
EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
OR' FILE YELLOW � INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
PrINAL
INK � OWNER GOLD � ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
t SETBACKS .............
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch
Retaining Wall ...........
Slab Insulation
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING:
fly\%
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 ..................
26063, 03q5
Tile Initials MT are Miltol,
inspectOr for the CitY.
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