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PERMIT
CITY OF EDMONDS I NUMBER X)
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CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTft
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO,
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0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required [3
Street Use Permit Required 13
CITY tip TELEPHONE EXISTING PROPOSED Inspection Required El
Sidewalk Required E3
REQUIRED DEDICATION _ FT Undprground
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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Building Permit
City Surcharge,
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
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DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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In 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSOR 5
Fire Review
Plan Chk. Deposit
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANC E
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Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee I
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
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GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC_
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TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
Building Official Or hi Ih D t , and Fees are paid, and
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING.TO
FOR INSPECTION
receipt is acknowled in space provided.
WOR MEN'S COMPENSATION INSURANCE AND RCW 18:27.
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s)6NATURE (OWN il AGEN DATE SIGNED
771-0220
PRELEAS bATE I
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ATTENTION
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-
ORIGINAL -FILE YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 If IRC110.
PINK -OWNER GOLD - ASSESSOR
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ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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A field inspection Nvas conducted to determine compliance with approved plans. Final approval
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notes that bjections from the abos signed Departme t to the release of
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RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fbmis:ocaprv1 Y25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......................
Wall...... ............ ........
Pier/Porch .................
Retaining Wall . ...........
Slab Insulation ..........
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..PLUMBING:
Underground ............
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Rbugh-In ...................
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Commercial Final ......
HEATING:
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Gas Test ....................
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Gas Piping ..................
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Equipment .................
Commercial Final .......
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EXTERIOR SHEATHING.
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NAILING ..........................
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'FRAMING ....................
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FIRST FLOOR FRAMING...
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INSULATION ..... ..............
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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