20000703.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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FRONT UR SIDE REAR
o C MPLIANCE OR
ADDITION CHANGE OF USE
PARKING
LOT AREA
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EV,-EDIIY DATE
REMODEL 0 SIGN
REDO I PROVIDED
r7N�NG
[3 REPAIR C] GRADING CYDS 0 FENCE X Fl)
EMARKS
DEMOLISH TANK ci OTHER
oGARAGE RETAININGWALL [3 RENEWAL
CARPORT ROCKER
ACTIVITY) EXPLAIN:
CHECKEDBY
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DESCRIBE RK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC IDS/FINAL INSPECTION REG
L 2A
VALUATION I FEE
PLAN CHECK FEE
HEAT SOURCE GILA ING%
LOT SLOPE %
BUILDING
AN C ECK NO:
VESTED DATE
PLUMBING
(W) - 3�
MECHANICAL
THIS PERMIT AUTHORI�ES oHl THE WORK NOTED. THIS PERMIT COVERS WORK 10
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION-
STATE SURCHARGE
PERM IT APPLICATION:, i BG DAYS
I YE
PERMIT LIMIT. 1 AR - PROVIDED WORK S STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;APPLICANT, ON BEHALF Or HIS OR HER SPOUSE. HFIRS� ASSIGNS AND SUCCESORS
AGREES TO DEFEND AND HOLD HARMLESS THE CITY OF
EI,IG, INSPECTION FEE
FIN we)
We"
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N INTEREST, �NDEMNIFY
i EDMONDS.WA HINGTON, TSOFFIC141-S, EMPLOYEES. AND AGENTS FROM ANY AND
EE
ALLCLAIMS FOR DAMAGES OF WHATEVER NATUR E, ARISING DIRECTLY OR INDIRECTLY
OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
CEIPT
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FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE
DEEMED TO MODIFY. WAI VE OR REDUCE ANY REOUIREMENTOF ANY CITY ORDINANCE
ANY ORDINANCE PROVISION,'
RECEIPT
E
3 NOR LIMIT IN ANY WAYTHE CITI-S ABILITY To NFORCE
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I 14AVE READ TH S APPLICATION. THAT THE INFORM TION
A PLICATION APPROVAL
GIVE S CORRECT. AND THAT I AM THE owNE Ii. OR THE DULY AUTHOF.ZED AGENT 01
"w' AND STATE LAWS AEGUI.ATI �G CONSTRUC
WITH CITY
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THE o NER. I AGREE TO COMPLY
TIO '. AND IN DOING THE WORK AUTHORIZED THERE.By. N PERSONWILL BE EMPLOYED
TO
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FOR INSPECTION
OLATI N OF THE LABOR CODE OF T HE STAT OF WASHINGTON RE LATING
IN VI o
DATE
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27,
OF CIALSSIGNATURE
S ATU
(425)
WoW
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771 -0220
EAS By
EXT 333
ENTIODK PYAB NG OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCU 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI,
ORIGINAL FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pler/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
q_1 00
Underground ............
9
C= ML
Rough -in
Commercial Final
0 C
HEATING:
M
Gas Test .............
Gas Piping ................
Equipment .................
-n
Commercial Final
1711 M
EXTERIOR SHEATHING
NAILING ..........................
0 fn
FRAMING ....................
FIRST FLOOR FRAMING...
0
INSULATION ...................
Floor Insulation
Wall Insulation
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Ceiling Insulation
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.......
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PERMITIEXPIRFS
USE PERMIT
000703-/
ZONE
CITY OF EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION 'AoDBRESS _
;?, �
_t% / S?APTl
1?., /4. ".(,
OWN111�10111NAMEOIBUBMEEIS PLAT NAMEISUBDIVISION NO.
-oo 11 No.
C��nvsf , oll,
I LID FEE $
MAILING ADDRESS r' — ' Anp...
J PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P Rl 0
'IN ,n.p.. n� .1- o
EXISTING — PROPOSED—
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FT Wn� 11-
c FRV SQUIRED
NAME
YES C3 No
REMARKS
ADDRESS
CITY zip TELEPHONE
NAME
INEERiNG
REVIEWED]—
ADDRE
r
r:TILi.
DATE
IIIIE REVIEWED El
clIT P
VARIANCE OR CU
SHORELINE OR ADBN INSPEETION BOND
STATE LICENSE NUMBER
REaD POSTED
oy.s NO
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7 �il_ SEPAREVIEW
COMPLETE EXEMPT
SIGN AREA HEIGHT
ALL ED PROPOSED ALL.0-D PROPOSED
—04
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PRoP1117;� A COUNT PAN- N.,
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11
LOT COVERAGE
RED D SET KS I PROPOSED SETBACKS (FT.)
U'RE
URSIDE REAR
0 NEW RESIDENTIAL PLUMBING I MECH A, -WED P11OPOSED
I RONT SID—EAU'R FRONT
COMMERCIAL COMPLIANCE Oil
0 ADDITION 0 CHANGE OF USE EDBY DATE
A
PROVIDED
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0 APARTMENT 0 .,.N REaD
0
0 REPAIR [3 �IENCE FT)
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0 DEMOLISH C] TANK (3 OTHER
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(3 GARAGE 0 RETA.IMNG� WALL. C3 RENEWAL
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TWITYl EXPLAIN
OF USE. BUSINE RA NS
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Hl
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NUMBER 'ETACAL
SPE'
OCCUPANT
0
ow ING A S
o' REOUIRED CO3 YES
LOAD
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a STOR His
DESCRIBE AK TO BE DONE
.1 REMARKS BC 1081FINAL INSPECTION REO'D
PROGRESS INSPECTIONS PER U
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VALUATION FEE
PLAN CHECK FEE 26�
DIF -
10
101 SLOPE
ullcE 11 AZING BUILDING
'2�o oo
Z
PLAN CHEC� NO: PLUMBING
MECHANICAL
0
THIS PERMIT AUTHORIZES ONLY T14E WORK NOTED. THIS IPERMIT COVERS WORK TO
ON THE PUBLIC
m
BE DONE GN PRIVATE PROPERTY ONLY. ANY CONSTRUCTION GRAIDI�)FILI.
DRIVEWAYS. MAROUEES. ETC,) WILL REOUIRE
DOMAIN icunes. SIDEWALKS.
SEPARATE PERMISSION,
STATE SURCHARGE
'E"MIlAP�lICAlION: 111001
IREP.11 LIMIT: I 11A,. PROVIDED WORK '. STARTED WITHIN $0 DAYS ENO REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'A PLlCANT.DNBEt4ALFOFHl OR 14EH GPOUSE, IIEIRS. A55IGNS AND SUCCESORS ENO. INSPECTION FEE
THE CITY OF 5 0j
INP INTERESI, AGREES TO :NO NIFY. DEFEND AND fIOLD HARMLESS
EM N
S. EMPLOYEES. A
TS ND AGENT S FROM ANY AND e�EE
',DLMCoND"iWF.A�4".'�No.To."�i.F WOFFiCIA
ATEVER NATURE ARI G DIRECTLY OR INDIRECTLY
S'N(
A
E OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
RECEIPT 11' 0 :�d
E OF TkIlS PERMIT
FROM THEISSUA iSSUANC
NC E
EQUIREMENT OF ANY CITY ORDINANC
DEEMED TD MODIFY. WAIVE OR REDU EAN
0 NOR LIMIT IN ANYWAY fijE CIIYS ABILITY TO ENFORCE ANY ORDINAN E PROVISION.'
TOTALAMO NT DUE
RECEIPT
IliEAElJYACKNCMlLEDGETkIAT:IIAVE READ THIS APPLICATION, THAT THE INFORMATION
APPLICATION APPF OVAL
GIVEN IS CORRECT, ANDTHAT AM THE OWNER, Dn THE DULY AUIVoRIZED AGENT OF
"UC
T I,,, ,,*n Inn.1l.nIll� On.d by in.
S RGU G
AlE A IA N NI CALL
THE OWN I AGREE TO COMPLY WITH C17Y AND STITY L
Ell W _, T' L Co p ED
L BE LOY
E.ij D II Vty� nd F� pid. nd
o ipt I, ,kl,dgPed in p9w pn�id,d.
o )HK AU tkIORIZ7ED THERE o ERS.N
TjoN AN D IN ojNCi
SU�.T. . TIN.
STATE F A N EIA FOR INSPECTION
IN VIOLATION OF TfliEl"LA" n CODE OF HE
So
WORffN'S.Sq�NfENSATION INSURANCE AND ACW 1IL27
OF IALS SIGNATURE DATb
11 ATUR� R AGENT) DAI E SIONIII/ (425)
Ll 2, 771 -0220
DAT
EASE By
.4
/ EXT 333
�/ATTENTIO!hy '
UNLAWFUL TO USE OR OCCUPY A BUIUDIf4G OR STRUCTURE UNTIL 771-0221
IT IS
A FINAL INSPECTION AS BEEN MADE AND APPROVAL OR A CrRTIFI-
ORIGINAL -FILE yELLoW.INSPE=R
ASSESSOR
CATE OF OCCUPANCYHHAS BEEN GRANTED. LIED SECTION 109 FAX
PINK -OWNER GOLD