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CHANGE OF USE
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DESCRIBE WORK TO BE DONE
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OWNER�ONTRACTOR RESPONSIBLE 'OR EROSION CONTROUDRAINAGE
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DATE
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COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (7.) PROPOSED SETBACKS (17.)
ALLOWED PROPOSED FRONT SIDE RE. FRONT URSIDE REAR
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VALUATION
PLAN CHECK FEE
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BUILDING
P"N CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Be DONE ON PRIVATE PROPERTY ONLY. ANY CONST FIU.TI.. ON THE PUBLIC
GRADINGIFILL
DOMAIN (CUflBS. SIDEWALKS, DRIVEWAYS . MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
RMIT APPLICATION; NIS DAYS
K IS
PERMIT 1.1.11, 1 YEAR - PROVIDED WOR STARTED WITHIN 110 DAYS
ENO. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ONSEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
ENO. INSPECTION FEE
;APPLICANT,
N INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
INSPECTION FEE
ECEIPT
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL HOT 8
DEEMEOTO MODIFYWAIVE OR REDUCE ANY REOIJIREMENTOF ANYCITYORDINANCE
PLAN CHECK DEPOSIT
NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE
TOTAL AMOUNT DUE
RECEIPT
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION APP OVA
131VEN IS COnRECr, A 0 THAT I AM
THE OWNER. I AGREE NTO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CJ LL
This pplicglial, is not a permit . I QmIlbll
Build, ONI,I,Iolht�.,D.PutY:-��dlIF&t�. r. P. ml
TOM AND I [NO TH ORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
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FOR INS ECTION tried
IN VIOLA N THE LA OR CODE OF THE STATE
WORKM E MPENSATION INSURANCE AND RCW 18.27.
OFF1 L IGNATURE
S7GNAfUR7VOWNEA Oil A DATE SIGNED
(425)
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7-
771
-
-0220
RELEASED BY D*E
ArrtNTION
E XT 333
OC
ITISUNLAW LTOUSE OqCdPY A BUILDING OR STRUCTURE UNTIL 771-0221
CtE�
A FINAL INSFUCTION HAT MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall ..........................
PladPorch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commerclat Final
HEATING:
Gas Test ....................
Gas Piping ............. ...
Equipment.................
Commercial Final . .......
IC
EXTER OR SHEATHING
NAILING .................
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation ._
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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0 REMODEL Cj APARTMENT C] SIGN
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F MARKS
OWNER�ONTRACTOR RESPONSIBLE FOR EROSION CONTROI-1DRAINNGE
FIRE REVIEWED By
DATE
VARIANCE OR CU SHORELINE OR ADS# INSPEC '-N
RED O-�Ilc
OYES 'N. In
SERA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LO COVERAGE REQUiREDSUBACKS(FT.) PROPOSED SMACKS (Fr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
PARKING I �TARSA 1PI-ANNINGREV1�1213BY DATE
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VALUATION FEE
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PLAN CHECK NO:
IVEITIO DATE
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PLUMBING
MECHANICAL
,MIT COVERS WORK 1.
THIS PERMIT AUTHO IZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0
U LIC
ON ON THE PUBLIC
BE DONE ON PRIVATE PR PERTY ONLY. ANY CONSTRUCTION ON THEP
GRADINGIFILL
B REQUIRE
OMAIN (CURBS. SIDEW LKS, DRIVEWAYS. MARQUEES, ETC.) WILL FIE.�iRE
SEPARATE PERMISSION,
PERMIT APPLICATION: ISO DAYS
PERMITLIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN IIIODAYS
ENG REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPlICANTOlBEHAL OF HIS 01 HER SPOUSE, HEIRS, ASSIGNS AND SUCCE101S
ENO. INSPECTION FEE
IN INTEREST, AGR99S TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-a�D,—,,N.
SOMON BE WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALLCLAIMSFORDAMA ESOFWHATEVER NATURE, ARISING DIRECTLYOR INDIRECTLY
INSPECTION FEE
- -
RECEIPT
I
FROM THE ISSUA CE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE 08 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANG
PLAN CHECK DEPOSIT
NOR LIMIT I N ANYWAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
RECEIPT
- —
TOTAL AMOUNT DUE
'��-7 2A
—uzs
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION
APPROVAL
APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. On THE DULY AUTHORIZED AGENT OF
Thl—PpIl-lon is net a p,,nNI,nI,I,ig,ld by In,
HE NER� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
T OW
HORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL ,d oftl.l ., Mann" Dept, and Fees a, paid. and
a P
I N; AN I IN T AU
i VIOLA P T"E LAGO COOE OF THE STATE OF WASHINGTON RE�ATING TO IFOR
I
INSPECTION ""' alodged In spaea p=ldd�
OR_ 'S� ENSAITION INSLIOANCE AND RCW 19,27.
OFFI L IGNATURE
(425)
SIGNATUREXO�fNEA OR �G�yTt;,
771-V44V -RELEASED
BY E
ATTENTION
EXT 333 ----------
IT IS UNLAWFULTO US�E 0 qcoFY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HASO� LN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL-FiLE - YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FA ASSESSOR
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