910105.pdf' USE PERMIT
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT
OWNER NAME/NAME OF BUSINESS ADDRESS
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\ SIGN AREA ENV. REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
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Tax Account Parcel No.
NEW DQ RESIDENTIAL
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REPAIR APT. BLDG.
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SETBACKS - FEET
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PLANNING REVIEW BY
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HEIGHT I LOT COVERAGE
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SPECIAL INSPECTOR AREA OCCUPANCY OCCUPANT
REQUIRED GROUP %�� LOAD
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REMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL. INSPECTION REQUIRED
VALUATION FEE
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission. STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year- Provided Work is Started Within 180 Days
"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 for damages of
whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the ATTENTION
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 THIS PERMIT
state laws regulating construction; and in doing the work authoriz- AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of the State of Washington relating to Workmen's Compensa- WORK NOTED
tion Insurance. INSPECTION
3IG TURE (OWN OR AGENT))DATE SIGNED �+ DEPARTMENT
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AurinuN�&_jd d / 1 CITYOF
EDTY OF
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CALL FOR
��INSPECTION
IT IS UNLAWFUL TO OR • OR 771 .
INSPECTIONUNTIL A FINAL A• • '• OR
A CERTIFICATE • OCCUPANCY
CHAPTER 3.
102-87
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
OFFICIA SIGNATURE ATE
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ELEASED 114 DATE
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ORIGINAL — File YELLOW — Inspector U
PINK — Owner GOLD — Assessor / 66
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RECORD OF INSPECTIONS
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INSPECTOR DATE APPROVED
SETBACKS . S . \ 14 ,111 • • • .
FOUNDATION:
Footing ........ ... .
Wall ...................
II' lit
Pier/Porch ............ .
{ Retaining Wall,...
PLUMBING:
Underground ...... I
Rough -In ....:........'
f CF..........:....•.
HEATING:
11. Gas Tes4.... .
Gas Piping . .
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Equipment ...:........
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FRAMING ....
-- -- SHEETROCK NAILING .. .
i SPECIAL INSPECTION .:
FINAL APPROVAL 'r7.
FOR OCCUPANCY ......
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