19990253.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMF NAME OF BUSINESS
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NAME
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PERMIT EXPIRES 1
PERMIT
2_0 NUMBER
JOB S0111 A"Tu
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9121 �Jl - """'71 ID NO
LEGAL DESCRIPTION CIIF(-,K SUBDIVISION NO
PORI K; HIGHT OF WAY PER OFFICIAL STREET MAP TESUP App,o.ed 0
HIN Pelmll Req .... ou 0
EXISTING— RFQUIREDDFDICATION_ Street Une Pom:t 9-�od 0
Impect,un Pentmeo 0
PROPOSED pe'lumccl 0
MET ER SI7E I INE SIZE NO OF FIXTURES PRV REQUIRED
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
LEGAL DESCRIPTION OF PROPERTY - INCLUDE ALL EASEMENTS
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< PROPERTY TAX ACCOUNT PARCEL NO.
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lipEW RESIDENTIAL PLUMBING I MECH
Ei COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APARTMENT Fl SIGN
GRADING FENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK OTHER
GARAGE E] RETAINING WALL RENEWAL
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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0 OF DWELLING AREAS
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DESCRIBE WORK TO BE DONE
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SOURCE GLAZING LOT SLOPE
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PLAN CHECK NO: IVESTED DAl E
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
M DOMAIN (CURBS,SIDEWALKS, DRIVEWAYS, MAROUEES.ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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w PERMIT APPLICATION: H10 DAYS
11. PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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in "APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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_j IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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cr EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 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
1HEOWNER 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 COMPENSATION INSURANCE AND RCW 18 27
SIGNATURE (OWNER OR AGENT) DATE SIGNED
REMARKS
ENGINEERING MEMO DATED
FIRE MEMO DA] ED
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT'
EXP I
A17EN ION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECI ION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
LOT COVERAGE
ALLOWED PROPOSED
LOT AREA
ADB#
SIGN AREA
ALLOWED , PROPOSED
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HEIGHT
ALLOWED . PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT IJR SIDE REAR
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PLANNING REVIEW BY DATE
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SPECIAL INSPECTt'�i
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OCCUPANT
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REMARKS
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PROGRESS
INSPECTIONS PER UBC
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FINAL INSPECTION REQUIRED
VALUATION
PLAN Cl IECK FEE
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PLUMBING
MECHANICAL
GRADING T-11-1.
SIATE SURGHARGII
SlOHM DRAINAGE FEES
ENG, INSPFCAION F[ E
PLAN CHECK DEPOSIT
FEE
TOTAL. AMOUNT DUE
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APPLICATION APPROVAL
CALL In i, pplical,on is not a permit until signed by tho
)qfficial or his/hol-D il ly Ind Fees are pdid and
-?din spare IF
FOR INSPECTION r� eipt is ackno dul! n sp irl pin don
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
ell
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
INSULAT
ION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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