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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
OWNER NAMIDNAME OF BUSINTS
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FLAT NAMESUBDIVISION No.
LID NO,
LOPES
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET
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0 MULTIFAMILY
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Description
Script'
FEE
Description
FEE
HEATSOURCE LOT SLOPE% VESTED DATE
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Slate Surcharge
Building Permit
Building Perim
City Surcharge
PLAN CHECK NO:
Plumbing
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Base Fee
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THI PERMITAUTHORIZESONLY THE WORK NOTE THIS PERMIT COVERS WORK To
BE 00 E ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Mechanical
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DOMAIN ICURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
PERMIT APPLICATION: SEE ECDC 19.00.005(A)JSi
PERMIT L MIT., SEE ECDC 19.00.001KABIB
it
Engr. Review
Recording Fee
Tno.. Inspection
Plan Chk. Deposit
SESSACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSOR$
IN INTEREST, AORE18 TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Fire ReView
Receipt 4
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
AL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FA M THE ISSUANCE OF THIS PERMIT. ISSUANCE Of THIS PERMIT SHALL NOT .
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINA NCE PROVISIOW
Fire Inspection
Total Amt. Due
Landscape Insp.
Receipt
Receipt
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, No THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I GREE 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
WORKMEWS COMPENS=tNSURANCE AND RCW 19:27,
CALL
FOR INSPECTION
(425)
APPLICATION APPROVAL
Thl� .1111-II-P '- - - 1-1- -� �19 �' I`i-
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DAT SIGNED
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771-0226
A- — 011166
LEASE04Y TE/
ATTENTION
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IT IS UNLAWFULTO 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. UBC1 09 1 IBC11 0 1 IRC1 10.
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK�OWNCR-GOLD ASSESSOR
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CITY OF EDMONDS 28460
DEVELOPMENT SERVICES
DATE:
Received of: i
Address: 7 1
Phone
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Permit/RePair
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Storm System Deveiopment charge
80
Disruption Fee (Street I bicewa[K / Parking Alley) Circle One
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E;5i;eeri�g R �view Fees
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Engineering Inspection Fees
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Engineering Plans/Specs
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Street Cut/Hestorallon Fee
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Trattic, impact Fee
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Fire Plan Check Fee
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B ilding Permit Fee - Type:
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Plan Check Feet'/
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Critical Areas
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SEPA Review Fee
Shoreline Permit Fee
Zoning Application Fee - I yp- I
ADB Administration reu
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Sign installation
Maps/Books
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Photocopies
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Recording Fee
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2Siarge
1ILMW charge (622 rundi
Received by: Permit No.
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slate, Insulation ..........
PLUMBING:
Underground .............
Rough -in ...........
Commercial Final
HEATING:
Gas Test ............
Gas Piping ..........
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING
—
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Calling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAN�
138NIi"Y ..................
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