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RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApraowd
RW Permit Required
1 street use Perma Required 13
—.-- PROPOSED Inspoclion Required 0
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
&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
a � '"S FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
REQ'D I PROVIDED
REMARKS
TYPE O-C N Ru TIO
OCCUPAN
GROUP
SPECIAL INSP CTION
REQUIRED YES
CONSULTANT
OCCUPANT
LOAD
REMARKS 2
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Gradi ng
Engr. Review.
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspet:
Receipt #
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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 CITY'S 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 AGREE 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
WORKMEN'S COMPEN 2!��= RANCE AND RCW 18:27.
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IG OWNER 0 A E DATE SIG)4ED
10.4 e2a"1111141_1z'A A01/21li-r-1
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Recording Fee
CALL
FOR INSPECTION
(eir-11
4251
771-0220
01,21111
lTotalAmt.Due I to_D,.(A_
Receipt #
APPLICATION APPROVAL
This application is nota pernia until signed by the
Building Otficial at hisitict Deputy: and Foes are paid. and
receipt is acknowledged In space provided
FICI
DATE
IDATE 1
ATIYENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1109 if IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wall ..........................
Pier/Porch .................
Retaining Wall ............
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blab, Insulation ..........
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PLUMBING:
Underground.............
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Rough -In ...................
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commercial Final ......
—40
0
HEATING:
MITI*
Gas Test ....................
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-Gas Piping .................
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Equipment ..................
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Commercial Final .......
EXTERIOR SHEATHING
M M.
NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
3:
Wall Insulation-.; .........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................