20050730.pdfCEIVED
EXPIRES
PERMIT
CITY OF EDMONDS
PERMIT
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NUMBER
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CQC( LS; -
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
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OWNER NAMEINAME OF BUSINESS
FLAT NAME ISUBDIVI SION NO.
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LID FEE S
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Rw Permit Requited
Street Use Permit Required
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CITY ZIP
9
TELEPHONE
EXISTING PROPOSED
Inspection Required
Sdewalk Requited
Underground
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NO. OF Fix rURES
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STATE
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EXPIRATION DATE
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RESIDENT IAL
ADDITION
COMMERCIAL
MIXED USE
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MULTIFAMILY
REPAIR
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GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BjJSINESS OR ACTIVITY) EXPLAIN
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FIRE REVIEWED BY
DATE
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PROPOSED SETBACKS (FT.)
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TYPE OF CO ISTRUCTION CODE
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NUMBER 1_�% ABER OF 9 1 02
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Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS F DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
-
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
T Y 0 D' A N C
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
E P R 0 V I S '0 N
0 CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
NOR LIMIT IN ANY WAY THE
Fire Review
Fire Inspection
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Recording Fee
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CALL
FOR INSPECTION
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
�ED AGENT a F
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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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
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEWS INSURANCE AND RCW 18:27.
,��NSATION
(425)
771-022
SIG7T6 ' �(OWNE' OR AG�VT):,..,-�
DATE SIGNED
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OCCUPANT 0
GROUP
OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge /5-
Base Fee TCN
Plan Chk. Depositl 1-1)
Receipt #
Total Amt. Due .22-1.
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or Im1hor Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
F - ICLKbS SIGNATILIfIL..". DAT
V� c, la ( , . i
_&SED BY I \ I IDATE 1.
ATTENTION t7t L 14,5,5 N�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- IGIZNAL
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1 09 / IBC1 10 / IRCII 10. PINK - I
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ... .....................
Wall ..........................
Pier/Porch ..................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
3:
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
Gas Piping .................
3:
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
FRAMING
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FIRST FLOOR FRAMING...
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INSULATION ............ ......
Floor Insulation .........
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Wall Insulation ........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL IN SPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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