960051.pdfCITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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Legal Description of Property - include all easements
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REMARKS
PROGRESS INSPECTIONS PER UBC 305
(TYPE OF USE. B{1sINESSOR A TIVITV) EXPLAIN:
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FINAL INSPECTION REQUIRED
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VALUATION
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MECHANICAL
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This Permit covers work to be done on private property ONLY.
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Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
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Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
STORM DRAINAGE FEE
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END. INSPECTION FEE
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"Applicant. on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the C1fy 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
modlly, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
PLAN CHECK DEPOSIT
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TOTAL AMOUNT DUE
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provision."
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I hereby acknowledge that I have read this application; that the ATTENTION APPLICATION APPROVAL
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• AUTHOP12Es This application is not a Dermit until
etl (hereby, no person will be employed in violation of the Labor ONLY THE signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
lion Insurance and RCW 18.27. INSPECTION acknowledged in space provided.
OV.'.ER OR AGENT( DAT SIGNED( DEPARTMENT
4�\1/� 11�3 CITY OF OFF( 5 ATURE OAT
'VTLLxiU' 1 1 EDMONDS
ATTENTION
ATTENTION
CALL FOR AT
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INSPECTION
IT
UNTIL
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CHAPTER
10207
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE -
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771 -0220 ORIGINAL — F.le YELLOW — Inspector
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
3. PINK — 0,-er GOLD — Assessor
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS, .................
FOUNDATION:
Footing ....................
Wall .......................
Pier/Porch................
Retaining Wall............
Slab Insulation............ -
PLUMBING:
Underground .............
Rough -In ................ -
Commercial Final........
HEATING:
Gas Test_ ................
Gas Piping ................
Equipment ................
Commercial Final.........
EXTERIOR SHEATHING -
NAILING ....................
FRAMING ....................
INSULATION:
Ftoorinsulation ..........
Wall insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ...... -
SPECIAL INSPECTION ......
IRADON MONITOR AT SITE.
FINALAPPROVAL
FOR OCCUPANCY........
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