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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICqATIONJOL
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PERMIT
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NAME
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ENGINLETING MEMO RATIO REVIEWEDBY
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SHORELINE
STATE LICENSE NUMBER El
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COMPLETE EMMET
SIGN AREA
MLOWED PROPOSED
HEIGHT
ALLOWED , PIT 11SED
LEGAL DESCRIPTION 01 PROPERTY INCLUDE ALL EASEMENTS
(_0-r &
LOT CoVERAGE
ALLOWED 111101109ED
REQUIRED SETBACKS FIT
FRONT SIDE REAR
1,6_ 1 _0
PROPOSED 'ETBACKS IFT)
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CHANGE OF USE
0 REMODEL
C] APARTMENT 0 SIGN
0 REPAIR
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REMARKS
PROGRESS INSPECTIONS PER UBC 108
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THISPERMIREAUTHO IZES ONLY THE WORK NOTED, TE4ISPEAMITc.V,flsWonKyO
BE DONE ON PTTIVATE PROPERTY ONLY. ANY CONSTRUCTION ON RIC PUBLIC
DOMAIN (CURBS.SIDEWALKS. DFIIVEWAY . MARQUEES.ETC) WILL n,.U,Fc
SEPARATE PERMISSION
I PERMIT APPLICATION 180 DAYS
PERMIT LIMIT: I YEAR � PROVIDED WORK 15 STARTED WITHIN Hill DAYS
-APPLICANT ON BEHALF OF RIS OR REH A, 11"oS All' FIT11,1
""1 11 MI-
I S TO �NDEMNIFY, DEFEND AND
N INTEREST. AGREE A.' "'A""
E WASHINGTON. TSOFFICIAIS E.Pl 011-11 .1JI A'.' 1�'t
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THEREBY ACKNOWLEDGE THAT I HAVE READ TI Ill All' 1A1 ION III ' VARON
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APPLICATION APPROVAL
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GIVEN 1$ CORRECT. AND THAT I AM THE OWNER OR THE DULY - Atil "1
THEOWNER I AGREE To COMPLY WITH CITY ANDSTATE LAWS;LGHLA) !,I._iT%N5tI IRL,
CALL IIL�l I.-h- , -t P.1-1 -l-I 1,
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FOR, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON LNL BE LARN(T To
.1 THE STATE OF WASHINGIO HE
FOR INSPECTION
IN VIOLA" ON OF THE LABOR CODE
WORKMEN S CoMPENSNTIONINSIL-RANCE IND RCW 182,
SCRIP
(425) oI Vjl�,Al S �IGNAILIIIC DATE
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SIGNATUR��R A� jill
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771-0220
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RELFAIF All
ATTENTION 6
IT IS UNLAWFUL TO USED, OCCUPY A BUILDING OR STRUCTURE UNTIL
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FINAL iNSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
Foirl ASSESSOR
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OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pler/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -In ...................
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Commercial Final
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HEATING:
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Gas Test ....................
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Gas Piping ...........
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Equipment .................
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EXTERIOR SHEATHING
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NAILING ..........................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
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FINAL APPROVAL FOR
OCCUPANCY .........
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PERMIT EXPIRE
... PERMIT
CITY OF EDMONDS 2- NUMBER 2()()q46
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CONSTRUCTION PERMIT APPLICATION JOB 8SS Sltd
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OWNER NAMENAME OF BU INESS
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MAILING ADDRESS fl
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CITY ZIP TELEPHONE
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NAME -vj -11 Im Al li M A-AJ
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CITY
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NAME
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STATE LICENSE NUMBER EXPIRATION CHECKED By
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LEGA; I OF P7DPEFlTY, INCLUDE ALL EASEMENTS
ar
Ll Ll roit2es-f -)72AC 7-5 1) V # 7-
PPIOPERTYTA. CCOUNTPAR�CEL NO.
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NEW Q RESIDENTIAL 0 PLUMBlNGIMECH
COMPLIA CE OR
E] ADDITION [3 COMMERCIAL 13 CHANGEOFUSE
C] REMODEL C3 APARTMENT C3 SIGN
ENCE
LEGA L DESCRIPTION CH ECK
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LID I'D
PUBLIC RIGHT OF WAY PER OFFICIAL STREET Al
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EXISTING - REOUIAE.DEGICATK)N-
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0
PROPOSED
0
IkETER SIZ S LINE SIZE NO. OF FIXTURES
PAV REQUIRED
YES C3 NO C3
MARKS
0���WEDBY
ENGINEERIN MEMOD
FIRE MEMO DATED REVIEWED BY
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VARIANCE OR CU
ABBI
SHORELINE N
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'SEFA Rii�
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED,, PROPOSED
ALLOWED PROPOSED
Ek,:��
_ 7, )- 14 -L ,,-
LOT COVERAGE ._
REQUIRE..ETBACKFJS�(FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
17T AS
FRONT URSIDE REAR
;I�BE
LOT AREA
PLANNING FEVIEW.Y OAT!
REPAIR 0 BRAD- -0 X FT)
UcT ON coo 'CUPANT
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OTHER
DEMOLISH 0 TANK
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FECIALEIIN.PECTIDS
o GARAGE 0 RETAI.1,1"r WALL ENEWAL RECIUR 0 YES
CARPORT A F.C. Y
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
RE.AR S
PROGRESS INSPECTIONS PER UBC 108
Is
NUMBER NUI
wttt ��d 4,72
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OF ') .
UN1111111 YA)MIll.- MEER
Q
STO IES
DESCRIBE WORK TO BE ..NE
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INAL INSPECTION REQUIRED
VALUATON FEE
PIIAN CHECK FEE
HEAT SOURCE LOT SLOPE I
BUILDING
2
n
IVA AN1.4
PLAN CHECK NO:
0 /1 2� 1
PLUMBING
MECHANICAL
THIS P UTHORIZFS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
.E=A N FRBVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
m DOMAIN LCURBS.SIDEWALKS. DRIVEWAYS , MAROUEES.ETC.) WILL REQUIRE
GRADINGIFILL
It SEPARATE PEGISSION.
2
STATE SURCHARGE
PERMIT APPLICATION: 18- DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
STORM DRAINAGE FEES
p OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENO. INSPECTION FEE
N%r.AES�.0At4.BENALF
;A
I TO INDEMNIF �LDEFEND ANG HOLND=LESS THE CITY OF
Hip P . �jy A TS FROM ANYAND
EDMONDS. WASHINGTON. ITS OFFIC S, EMPLO US
AULCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLY On INDIRECTLY
PERMIT SMALL NOT BE
F ANY CITY ORDINANCE
PLANCHECK EP SIT
ROMANCE PROVISION.'
TOTALAMOUNT UE
I HEREBY ACKNOWLEDGE THAT I HAVE.AEAD TH "App"CA"O" -THATT21""ORM iON
EF` . THE CIULY AUT.. IZED AGENT OF
APPLICATION APPROVAL
GIVEN IS CORRECT, JE OW
WNER 'A.R�AND THAT I AN T
THEO . EE,.COMPEY WITH CITY AND STATE LAWS REGULATING CONSTRUCw
CALL TH. pPls- J- is net . P signed by line
Deputy: end Fee. .. Fide, end
TiFE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
T,.VN,,,ALNo RELATING TO
J, g hi.,her
"n, n
FOR INSPECTION -PI knllIldged,,, sp- p-ldld.
INNDoIFNG
IN AT, 0 TH LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE AND RCVV 1827.
TE;
OFFICIALS SIGNATURE DATE
(425)
7SI�CNA �FlAffNT),,
a L
If7l i�ltff- 3- 115 �,5
771-0220
B
RELEASE
ATTENTION 11.
ITISUNLAWFULTOUSEOR OCCUPY ABUILDINGPOR STRUCTURE UNTIL,�7f_o
A FINAL INSPECTION HAS BEEN MADE AND AP ROVAL OR A CERT-IrA-
ORIGI NAL - FILE YELLOW INSPECTOR
GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109
PI NK - OWNER -
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