20000280.pdfRECEIVED
CiTY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
MAILING ADDRESS
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NAME
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PILAT NAMEISUBDIVISION NO. LOT NO� IDNO,
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXIS ING — PROP SED
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SIGN AREA HEIGHT
ALLOWS io PROPOSED
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LOT COVERAGE REQUIRED SETBACKS CFT.1 PROPOSED SETBACKS (FT)
ALLOWED PROPOSED' FRONT SIDE REAR FRONT UR SIDE REAR
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REMARKS
— ".Pzq INqPrCTIONS PER UBC 1081FINAL INSPECTION
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VALUATION FEE
PLAN CHECK FEE
HEAT SOURCE .1-AZING I LOT SLOPE %
BUILDING
PLAN CHECK NO: �EITIO DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES DNLIIHE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIRLL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
n SEPARATE PERMISSION.
t:
STATE SURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
5NG. REV15W FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
HALF OF HIS OR HER SPOUSE. HEIRS. ASSIONS AID SUC ES-FS
AND HOI HARMLESS THE CITY OF
RE 0
ENG. INSPECTION FEE
LANDSCAPING
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EDMONDS.
ALLCILMMS FOR DA.AGE� OFWHATEVEn NATURE.ARISINGDIREIILT-
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RECEIPT
F E P EF.
ROM TH SSUA OF THIS PERMIT. ISSUANCE OF THIS
CITYORDINAN E
AN CHECK DEPOSIT
PIL HECK DEPOSIT
E YREO MEMENTO ANY
WAIVE OR REDUCE
DEEMED TOMOOIFY0 AN U OF
RCEANY ROMANCE PROVISION.'
RECE'll
X NOR UMIT IN ANY IN OENF
AY THE CITY'S ABILITY T a
TOTALAMOUNTIDUE
THAT THE.N.Fo"AT'ON
APPLICATION A PROVAL
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AIPU�CEATIULNY.
THE OWNER. OR T C AUT.D.Z ADEN,
Tl,,� PpIl. 11- -� - A P-1 9— �'
GIVEN 13 CORRECT, AND THAT I AM
LAWS IEGULATILNG Co T'
THE OWNER. JAGREETO 0 MPLY WITH Cl Y AND STATE INS UC
CALL
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1 .1 D pu'Y:
TION� AND IN DOING THE W RK AUTHOR ED THEREB , NO PERSON WL "' EMPLOYE
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RELATING To
FOR INSPECTION �k l�dl. P—ld-1
IN VIOLATION OF THE LAOR CODE OF THE STATE 0 , WAS.I N.T.N
ED
WORKMEN'S COMPENSATION INSURANCE AND RCYV 1BZ7.
(425)
OFFICt LS I U
SIGNATURE (OWNER OR AG DATE
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771-0220
IEL S5DB D E
EXT 333
ATTENtION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
L-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YELLOW MSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
PiedPoTch .................
Retainirig Wall ...........
Slab insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping
Equipment
Commercial Final
EXTERIOR SHEATHING
NAILING .................
FRAMING........................
FIRST FLOOR FRAMING
j
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling insulation
SNEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
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FINAL APPROVAL.FOR
OCCUPANCY ...... ...........
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF SU INESS
PLAT NAMEISUBDIVISION NO. 10T�M UO NO.
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REOUIREDDEDIC.TION FT
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY �TE
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TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOW ED PROPOSED
PROPERTY
EXP
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DESCRIBE WORK TO BE DONE
REMARKS SPE
PROGRESS INSPECTIONS PER UBC 108/FINAL IN CTION REQ'Dj
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VALUATION
FEE
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PLAN NO: ESTED DATE PLUMBING
MECHANICAL
HI%PE�A.MNITA�JTHFORAMESOi4L,��NEWdAK�bTe6. THIS PERMIT COVERS WORK TO
* I IT 'D
NE . JIV TE
E ED
BE - - PR""S'PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADINGIFiLL
fCHECK
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
L
SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATIONt 180 DAYS
PERMIT LIMIT'. 1 YEAR, - PROVIDED WORK IS STARTED WITHIN 180 DAYS END. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
C
ENG. INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF LANDSCAPN.
WASHINGTON ITSOFFICIALS EMPLOYEES, AND AGENTS FROM ANYAND INSPECTION FEE
m EDMO .
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
REC IPT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS SHALL NOT BE
PLAN CHECK DEPOSIT
FPERMIT
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT 0 ANY CITY ORDINANCE
TO ENFORCE ANY ORDINANCE PROVISION,
RECEIPT
NOR LIMIT IN ANYWAY THE CITY'S ABILITY
TOTAL AMOUNT DUE
f,�
I HEREBY ACKNOWLEDGE THAT I HAVE REA. THIS APPLICATION; THAT THE INFORMATION
c_ -e- If
APPLICATION APPROVAL
GIVEN 15 CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
LAWS REGULATING CONSTRUC
CALL
Th,'I _ _ A P._j .�Jij .,Q�.d b, 11.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE
THEREBY. NO PERSON WILL BE EMPLOYED
B1,1d,19 Olf6al ., hi./- D,p ,d, Ild
I
=�P
TION; AND IN DOING THE WORK AUTHORIZED
CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
, I
roc"p- d
IN VIOLATION OF THE LABOR
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27,
05FICIALS SIGN U
SIGNATURE OWNER OR AGENTI
E IGNE
(425)
6,00 1
22Z4,--:
771-0220
F,L ASEDB D*E
EXT 333
AFFENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDIN G 08 STRUCTURE UNTIL
771-0M
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR