20000643.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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EXP
LOT COVERAGE
REQUIRED SETBACKS (FTJ PROPOSED SETBACK$ (Fr.)
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ALLOWED PROPOSED
FRONT SIDE REAR FRONT UR SIDE REAR
0 ADDITION COMMERCIAL
cl COMPLIANCE OR
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PARKING
LOT AREA PLANNING REVIEWED 81 DATE
REMODEL APARTMENT
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FENCE
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REPAIR [3 GRADING CYDS 0 — X FT))
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HEAT GLAZING I LOT SLOPE %
BUILDING
PLAN CHECK NO: VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVER WORK TO
CTION ON THE PUBLIC
t: BE DO Al 0 N PRIVATEEPI.OLPE.RT.I.OHLY, AN' G-.Q�URU
MAR EES, ETC.) WILL REQUIRE
GRADING/FILL
K � QWAYE.
DOMAIN (CURBS. SID BE AFIATE PERMISSION
STATE SURCHARGE
N PERMIT APPLICATI N! 18B DAY.
PERMIT LIMIT. 1 AR ROVIDED WORK S STARTED WITHIN 180 DAYS
YE P
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION ,
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS� ASSIGNS AND SUCCESORS
TEREST. AGR' ES TC CIFIND AYNESSOLD HARMLESS THE CITY OF
LANDSCA NG
%IN. DS WA 'HIN.T.H S. EMPL. AND AGENTSFROM ANY AND
OFF, �LD
! �TNDEMNI�;y
E N , NATURE. ARISING DIRECTLY OR INDIRECTLY
IN5PECTIO FEE
ALI-,C-"MSFORDNAMAGEFSTo.,�W"ATEVTER
SLA PERM ISSUANCE OF THIS PERMIT SHALI NOT BE
PLAN CHECK DEPOSIT
M T
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I E'NIED TO MODIFY WAIVE OR REDUCE ANY PEOUMEMENTOFANY ITYORDT NC�
D ENFORCE ANY ORDINANCE PROVISION.
I
NOR LIMIT IN ANY W�Y THE C I Y'S ABILITY TO
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVTEREAD T"'�EAPPTLICEATION; THAT THE INFO ATICN
OR DUL AUTHORIZED AGENT OF
E WNE
GIVEN "o"REZEANDT"ATFLYM "HC Y AN6 STATE LAWS REGULATING CGNSTRUC-
WI' IT
CALL
-.-ER. 'AG- T----
TION. AND IN 0 TH )RK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
0 NG EW L G TO
RE ATIN
FOR INSPECTU
IN VIOLATION o � THE LAB R CODE OF THE STATE OF WASHINGTON
WORKIYENSCOMPENSARO RANGE ANDRCW ;8.27�
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(425)
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771-0220
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EX 1'1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
519.
VALUATION I FEE
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APPLICATION APPROVAL
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PINK OWNER- GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DAT E APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Potch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .................
p
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
ST FLOOR FRAMINIr
INSULATION ...................
Floor insulation
Wall insulation ...........
Ceiling Insulation
SVIEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .............
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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METER SIZE
I LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
YES 0 No 0
ADDRESS
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EMARKS
E M A R S
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FRONT SIDE REAR
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A.W.ITION COMMERCIAL 0 CHANGEOFUSE
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ED By DATE
REMODEL APARTMENT C] SIG14
REOC I PROVIDED
GRADING E] FENCE X
[3 REPAIR CYDS X FT)
EMARKS
DEMOLISH C] TANK OTHER
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D GARIGRT ET RETAINIRNY, WALL 10 RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKEDBY
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REOU R [:] YES LOAD
DESCRIBE WORK TO BE DON E
REMA KS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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121 [.A,%
VALUATION
FEE
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PLAN CHECK FEE
GLAZING % LOT SLOPE % BUILDING
_�LAN CHECK NO: PLUMBING
MECHANICAL
PERMIT COV I RKTO
THIIS.PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS E S"O
E .NE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADING/FILL
A. 'CUR.S. SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARArE PERWISSI N.
STAT� SURCHARGE
fE - PERMIT APPLICATION' 180 DAYS' ENG. REVIEW FEES
P T LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HELPS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF LANDSCA NG
2 EDMONDS. WASHINGTON. tTSOFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND INSPECTIO FEE
ALLCLAIMS FOR DAMAGESOF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
a DEEMEDTO MODIFY.WAIVE OR REOUCEANY REGUIREMENTOF ANY CITY ORDINANCE
0 NORLIMITINAN WAY THE CITY'S ADILITY TO ENFORCE ANY ORDINANCE PROVISION.' R IT
Y 00
I OTAL AMOUNT DUE
Y ED AGENT OF &(Ot APPLICATION APPROVAL
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION 7kc
GIVEN IS CORRECT. AND THAT I A. THE OWNER, OR THE DULY AUTHORIZ h - P—It lltII Slglld by Ihe
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL E IT � appl,cal,� -
0 OYED dllg 011,,w , h,.Ih,, D,pl,. :,.d F .1,1
TIOM; AND IN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPIL TO vocopt is acknow!Odp�,� p,d.d
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING FOR INSPECTION
WORKMEN'S COMPENSATIO ., �URANCE AND RCW 18.27� OMCIALS SIGNATURE DATE
I NED (425)
Tj J
I w 771-0220 R , E EASED BY (I
ATTENTION EXT t333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION
CATE OF. CCUPANCY HAS BEEN GRANTED. UBC SECTION 1 09 FAX PINK - OWNER GOLD - ASSESSOR
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