20000275.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS ,
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PERMIT EXPIRES
USE
PERMIT ZOGZ75
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14UMBER
JOB
ESS Sul E/ PT
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FLAT NAM111UBDIVIIION NO,
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LED NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED�
DEDICATION FT
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METER SIZE
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REMARKS
RESPONSIBLE R EROSION COI4TIEOLJ.RAINA..
T T OR
J.CITY
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NAME
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ENGINEERING
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DATE
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STATE LICENSE NUMBER i
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SERA REVIEW
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EXP
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SIGN AR
ALLOWED I 101011D.,
ALLOWED PR7
PROPER TY TAX ACCOUNT
L� 6 We?
I TI L C] PLUMBING / MSCH
PEW S DEN A COMPLIA CEOR
0 ADDITION OM 0 AL 0 CHANGE OF USE
0 REMODEL C3 �AEPAFETMENT 0 SIGN
0
GRADING CYDS FENCE X FT�
0 REPAIR n ( — _
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0 ARAG' 0 RETAINING WALL RENEWAL
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IRE x
.2 NUMBER F pf CRITICAL
Ed NUMBER 0 AREAS
OF DWELLING
0 STORIES I ... T. NUMBER
LOT COVERAGE RECURRED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR
PROPOSED SETBACKS JF`L)
FRONT A US SIDE REAR
PARKING
PROVIDED
LOT AREA EVIEV
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H �CKEDSY ITYPE 11�1101,1
C.UANT
UP
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LOAD
DE�CRJBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION RED
'VIA & --s
cl
VALUATION
FEE
PLAN CHECK FEE
HEAT SOURCE
GLAZING %
LOT SLOPE
BUILDING
PLAN CHECK NO:
� � \
PLUMBI G
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADRIGIFILL
DOMAIN (CURQ$, SIDEWALKS, DRIVEWAYS, MARQUEES, STC.) WILL REQUIRE
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: 100DAYS
I PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE SACK OF PINK PERM MORE INFORMATION
END, INSPECTION FEE
"HE SPOUSE� HEIRS. ASSIGNS AND SUCCESORS
' R Y OF
;AP,ILI.l�A.'�Ti,l�I."IAITI.IFHI
N END MINIFY, DEFEND AND HOLD HARMLESS THE CIT
NT SEES ANYAND
LANDSCAPING
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM
ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
ALLCE�MMSFOFEDAM ESOFWHATEVER NATURE.
AG THIS PERMIT ISSUANCE OF THIS PERMIT SHAUL NOT BE
OF OF
PLAN CHECK DEPOSIT
H"5SU AN
'ROM T DEFY R .U..ANYR EOUIREMSNT OF ANY CITY ORDINANCE
I)EENS"...
HOSU.ITINAHYW Y Egy� NFORCE ANYORDINANCE PROVISION
SAELI�Toe
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPUCATION� THAT THE INFORMATION
AGENT
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED CF
G_
LY T
To COM' W
LY WITH CITY AND STATE LAWS REGUUaTEN.GscE0,NsLOYED
CALL
NED E A EE '
W" R I GR
T OR THEREBY, NO PERE., L
T .H A IN ".IN. THE -SH AU 'Z'D'
NO
INSPECTII
IN ELATION F T E LIMED R C-E OF T HE STATE OF WAS.GTOH FEEL AT G To
V,.
FOR
WORKMEN S COMPENSATION INSURANCE AN. Z1
SlGINATU (OWN A I
DATE SIGNED
G�
(425)
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;AENTIO
13 JG-, 06::1
771-0220
EXT 333
-
IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
771-0221
IT
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
A FINAL
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................
FOUNDATION:
Footing ............
wait..........................
Pier/Porch .................
:it
I o
Retainirig Wall ...........
Stab Insulation
PLUMBING:
Underground
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Rough -in ...................
a
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Commercial Final
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HEATING:
to -4
Gas Test ....................
> Z
Gas Piping ................
Equipment ..........
-n
Commercial Final
m m
EXTERIOR SHEATHING
r
0
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NAILING ..........................
FRAMING........................
FIRST FLOOR fRAMING...
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INSULATION ...............
Floor Insulation
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Ceiling Insulation
SHEETROCK NAILING
0
SPECIAL INSPECTION
m:
MISCELLANEOUS ..........
FINAL APPROVAL FOR
A.
OCCUPANCY ..................
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ATE RECEIVE -
PERMIT EXPIRES
QE_
PERMIT 200275
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
SUITE/APT#
ADDRESS o (4-0,
OWNER NAMEiNAME OF BUSINESS,
PILNT NAMEISUBDIVISION NO.
LOTp. v
LID NO,
LID FEE S
MAILIN OBSESS
Ay PER OFFICIAL STREET MAP
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0
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NO, OP FIXTURES
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NAME
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OWNERICONTRACTOR AESP�NJSIBLE FOR EROSION CONTROLDRAINAGE
ADDRESS
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ADDRESS
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PROPOSED SETBACKS (FT.)
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ALLOWED PROPOSED
FRONT SIDE REAR
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PEW
COMPLIANCE OR
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REMARKS
9 OTHER
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CHECKED BY
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NUMBER
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NUMBER OF
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PC
CRITICAL
AREAS
NUMBER
To
SPECIAL INS AREA
IYE.
REQUIRED 0]�
OCCU NT
LOAD
0
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ
0
a V)
5
i r
E, 20.-sv
R; s
z
j,
VALUATION
FEE
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PLAN CHECK FEE
1) HEAT SOURCE GLAZING T6 LOT SLOPE I BUILDING
m
PLAN CHE K NO: VESTED DATE
PLUMBIN
ECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURB$, SIDEWALKS, DRIVEWAYS. MARQUEES. FTC,) WILL REQUIRE
SEPAR PERMISSION.
STATE SURCHARGE
PE MTAPPLICATION: 18A DAYS
4
PERMIT LIMIT, 1 YEARMPIA'OVIDED WORK IS STARTED WITHIN 180 DAYS
s
SEE BACK 01� PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALFOO HIS OR HER SPOUSE. NEInS,AS IGNS AND SUCCESORS
ENG. INSPECTION FEE
IN MT111ST.=,rQ`., INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-2 TS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
LANDSCAPING
INSPECTION FEE
E _W
1 G.ONS,
IF OFWHATEVER NATUME� ARISING DIRECTLYOR INDIRECTLY
�SL�n,,,FOR DAMAGES
OF THIS PERMIT. ISSUANCE 01 THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
RECEIPT
OFANY CITYORDINANCE
DROMAN—
TOTALAMOUNTDU15
RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAYTE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION A! AL
I AM HE OWNER. OR THE DULY A H MIZE A N
GIVEN IS CORRECT, AND THAT LY WITH CITY AND STATE LAWS E U It GO NSTRUC
To COMP
CALL
�,r!10
lu".1,10,11 "d Fit _.V."
T NER 'A EE ILL BE EMPLOYED
HE OW IN G OF "
- IS W
TI.N AND N .. AUTH THEREBY, N PE S ME
N LATINS, T
FOR INSPECTION .ipt,., Al.�pd m -
CODEORIZED
E AS INNT
- A T. LABOR 0 THE STAT OF
IN W L TON 0, E
WORKMEN S COMPENSATt.NNSURANCE AND HOW 18�27,
FICIALS SIGNATURE D E
JOINED
(425
a)
StGN� OW`r
771-02�20 E
ENTOI,l -eN QAXT 333
f-""
OR OCCUPY A BUILDING OR STRLJCTUI�-
ITISUNLAWFULTOUSE S
771-0221
A FINAL INSPECTION HAS BEEN ADE AND All ,
ORIGINAL -FILE - YEL INSPECTOR
PINK -OWNER GO ASSESSOR
tll*��
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
FAX