20051127.pdfDATE RECEN .
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS
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Description
FEE
Description
FEE
Plan Check
State Surcharge
TSLX % VESTED DATE
,IgURCE I
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
THI PERMIT AUTHORIZES ONLY THE WORK NOTED. THISPE MITCOVERSWORKTO
Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
EPARATE PERIWSSION�
Grading
PERMIT APPLICATION: SEE ECOC 19.00.005(A)(5)
Engr. Review
Engr. Inspection
T SEE a PERMIT LIMIT SEE ECDC 19.00.005(A)(6)
ACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDE NIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire inspection
Receipt
AL CLAIMS FOR DAMAGES 01 WHATEVER NATURE, ARISING DIRECTLY OR I DIRECTLY
FIR M THE ISSUANCE OF THIS PERMIT, ISSUANCEOFTHIS PERMIT SHALL NOT BE
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DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT ORDINANCE
Landscape Insp. I
Total Amt. Due
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NOR LIMIT IN ANY WAY THE CHN'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee
Recript#
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
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-
CALL
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TION: AND IN GOING THE WORK AUTHORIZED THEREGY� NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION 1P Pd,d
WORKMEN'S'��SATIO�IUININCE AND NEW 1111,
DATE
T DATE SIGNED
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771.0220
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IT IS UNLAWFUL TO USE 0 R OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW - INSPeCrTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110.
PINK -OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ............
FOUNDATION:
Footing ......................
wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
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Equipment ..........
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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
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Ceiling Insulation
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SHEFTROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................