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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
TELEPHONE
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MIT EXPIRESI
6SE PERMIT aw s/
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ADDRESS
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PI -AT NAMEISUEDIVISION NO.
I LOT NO
LID NO.
LID FEE I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING— PROPOSED—
........ .....
REQUIRED DEDICATION— FT
PRV REQUIRED
YES 13 NO
2.=.KlSTlIlTlR R—p—siBLE FOR EROSION CONTROUDRAINAGE
EEFING
REVIEWEDIDATE
ADDRESS
FIRE REVIEWED BY
DATE
CITY
VARIANCE OR CU
SHORELINE OR AOBN INSPECTION
STATE LICENSE NUMBER
E.FIR ON
IPBO
CSTNEO
E2YREO,
Es ONO
SERA REVIEW
SIGN AREA HEIGHT
C OMPLETE EXEMPT
ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT RAPID L NO.
_m�—o
t o
EXP I
I ,
LOT COVERAGE
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FF.)
0 NEW
RESIDENTIAL
PLUMBING I MECH
ALLOWED PROPOSED
FRONT SIDE REAR FRONT UR SIDE REAR
0 ADDITION
0 COMMERCIAL
C MPLIANCE R
CHANGEOFUSE
PARKING
LOTA-__
0 REMODEL
[3 APARTMENT
SIGN
REOID I PROVIDED
0 REPAIR
FENCE
cl I X FT)
C] DEMOLISH
TANK
OTHER
I�IARAGET
A. 0
IIETAft,�,, WALL RENEWAL
C, ROCKS, [3
R ACTIVITY) EXR�
CHECKED By YPE .1 COW lq&71 GCCUUPANTU
UMBER F
CRITICAL
SPECIAL INSPECTOR AREA OCCUPANT
DWELLING
U NITS
AREAS
U MBER
REQUI RED C3 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO
VALUATION I FEE
PLAN CHECK FES
LIT SLOPl,,qj
ia 12
IU ICING
AN CHECK NO: VESTED DATE
MECHANICAL
y THE WORKNOTED, TMSPERMITCOVI� PIORKTO
11111 PERMIT AUTHORIZE' ONL Y ANY DONT
:2 DONE .N PRIVATE PROPERTY ONL . RUCTION ON THE PUBLIC
OMAIN ... S. S..WAL.S'..'__.,.. AR..EES, ETC.) WILL REQUIRE
HEPARATE ..... S...
r
GRADINGIFILL
STATE SURCHARGE
P 'RMIT APPLICATION 180 DAYS
PERMIT LIMIT.- I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENO. REVIEW FEES
;A"L'CANTj"A'.BEHA'F OF HIS OR HER SPOUSE. HEIIIS, ASSIGNS AND SUCCESORS
, INTERES R ES TO INDEMNIFY. DEFEND AND HOLE) HARMLESS THE CITY OF
E MONDS,WAIMINIIIN ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING OIRECTLYOR INDIRECTLY
FA M THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED 0 MODIFY. WAIVE OR RED CE ANY REQUIREMENT OF ANY CITY OFIDIN�NC
0 U
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
ENG. INSPECTION FEE
LANDSCAPIN
iNSPECTIONFEE
PLAN CHECK DEPOSIT
TOTALA.OUNTOUE
BE
RECEI
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVE IS CO ENR6 SoTATH, OULy AUTHORgl.115 AGENT 01
RECT, AND THAT I AM THE OVVt
' W A TE LAWS REG. C
THE 0 NER. CONSTRU
AGREE To COMPLY WITH CITY
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. N PER ON WILL BE EMPLOYED
0 S
WASH[ GTON
IN VIOLATION OF THE LABOR CODE OF THE STATE OF N RELATING TO
WORKMEN S DO INSURANCE AND RCW 18.27.
.YgkNSATION
SIGN�IL: 0
,ZAGENTI DATE SIGNS
CALL
F 0 R INSPECTION
(425)
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APPLICATION APPROVAL
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IALS I NATURE DATE
RELEAS9DW3Y
ATTENTION
EX 11333
--------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIt
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
It 1 v4r- 1
FAX
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER - GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Undergroun d ..........
Rough -in ...................
Commercial Final
HEATING:
Gas Test ....................
Gas Piping .............
Equipment .................
Commercial Final
EXTERIOR 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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PERMIT
ZONE
CITY OF EDMONDS - k/9- 9:? NUMBER 1900"17
JOB C SUIT APT,
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWtnAMENAME OF BUSINESS
PLAT NAMFJSUBDIVISiON NO. I LOT 10, 1-1
MAILING ADDRESS 'Ed '-. ,h-d
P h R.'
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP h_ P
2— EXISTING — PROPOSED
TELEPHONE S. k F.,.e.d
CITY um ._
_uh.
REQUIRED DEDICATION — F7
Al RV R
62POUP�-, METER SIZE LINE SIZE NO. OF FIXTURES PRY REQUIRED
NAME YES 0 NO C3
.5g-E REMARKS
I-- —.0—INTRACTOR RESPONSIBLE FOR.EROSION CONTROUDHAI"GE
CITY
-------- --
NAME
NAME.
-
E.FIN.
ADDRESS
ADDRESS
FIRE REVIEWED BY DATE
IT' -U`
CITY
TELEP14ONE
VARIANCE OR CU SHORELINE On ADBN
'p CT'ON
INSRpg�T
I "ION
RED C
ONCID
'ON"
STE
POSTED
I'D
E LICENSE NUMBER EXPIR`TIO
'ATE LICENSE NUMBER
ES '3 No
OYES 0190
REVIEW SIGN AREA
COM L - E EXEMPT ALLOWED PROPOSED
HEIGHT
HEIGHT
P POSE
OWED PROPOSED
ALLOW.
R ,4ACC01 NT PARCEL NO.
opEnTy TAX
t 0 13
EXP I
I
—wi—o
LOT COVERAGE REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT)
POSED SETBACKS 'PT I
NEW RESIDENTIAL [0] P MBINGIMECH
ALLOWED. PROPOSED, FRO HIT �.SIDE REAR,
FRONT URSIDE REAR
)NT UR SIDE FEAR
DO PLIANCEOR
0 AUDIT'.- 0 COMMERCIAL CHANGEJDF USE
PA LOT AREA
RKING
PLANNING REVIEWED'BY
DATE
0 REMODEL APARTMENT SIGN
RED. D I PROVIDED
E
REPAIR 0 FACING rYD. [] F -- X FT)
REMARKS
DEMOLISH [3 TANK ci OTHER
CA R 111. WALL
PAGE ETAIN C) RENEWAL
-"RP
(TYPE OF BUSINESS
CHECKEDBY
OF CONST
111E OF
NUMBER
I
NUMSERI)F
DWELLING
CRITICAL
AREAS
SPECIAL INSPE OR
C CUPANT
PO AD
1 -9 -) 41.
OF
�STOHIES
UNITS
NUMBER
REQUIRED C](�
J�
DESCRIBE WORK TO BE DONE
REMARKS
PRO GRESS INSPECTIONS PER USC 1081FINAL INSPECTION REC1'
5
FEE
PLAIN CHECK FEE
T SLOP
HE
BUILDING
12.
PLAN CHECK NO:
HANICAL
THIS PERMIT COVERS WORK TO
NOTED TO
THIS PERMIT AUTHORIZES ONLY THE -OBX
'ATE PROPERTY OHL Nye INSTRUCTION ON THE PUBLIC
BE DONE ON PR' A 6
MARQUEES, ETC,) WILL REO IRE
GRADINGIFILL
00 LKS.C,IV—S,
MAIN (CURDS. SIDEWA SEPARATE PERMISSION.
STATE SURCHARGE
PERMIT APPLICATION: IDD DAYS
PERMIT LIMIT. I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
;NAFP.L,�..A�N.TiOA�..EHAL, , HIS OR gR�I..SE. AMP. - ASSIGNSANDTSHUC SSORS
F ES To 'NCEMN . E END AND HOLD HARMLESS E CITY OF
ENG. INSPECTION FEE
LANDSCAPING
0" TS "
EDMONDS I'AIHI ON O.F CEAS
gjA.T,�L�.�Y%S�jAVIDAGENTS IF.. ANYAND
INSPECIION FEE
. W V, 11
�
LL 2A E�GF AT ING OIRECTLY OR INDIRECTLY
A .RGA NOT BE
R I
NYITI SHALL
,=,THIS PERM
FROM THE ISSUANCE OF THIS PERMIT ISIr A C TV ORDINA CE,
OF
RLAN CHECK DEPOSIT.
ENFORCE ANY ORDINANCE PROVISION"
TOTAL AMOUNT DUE RED
AT, " THAT THE INFORMATION
THAT I HAITEHFI.ADTHIS A.'�ILHCE
APPLICATION APPROVAL
I HEREBY ACKNOWLEDGE
15 CORRECT�AND T1.1A.T,'LA'W' E WNEF DULY AUTHORIZED AGENT 01
T Is pplinfiw i. P—IT lhIII.,ghld by he
GIVEN
THE OWNER. , AD. TO. ITH CITYAN6 STATE LAWS FI2.UI.ATING CONSTRUC
BE EMPLOYED
CALL u,Id,,g Olu-1 , hil-I D,pVty: and Fell — Plid. I'd
NO WORK AUTHORIZED THEREBY. N PER ON WILL
'ICV..AL No'� 60F THE 0 SNGTON RELATING TO
E WASH[
OF
ipt i. -k—I,dgad ih p,.a p—ded.
FOR INsPECTION
T A OR CODE OF THE STAT
IN " ATION . HE L
COMPENSAT18ON INSURANCE AND RCW 18.27.
IALS IGNATURE DATE
WORKMEN'S
(425)
771-0220 RELEA Y DATE
EXT1333
ATTENTION
IS UNLAWFULTO USE 08 OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
IT
A FINAL INSP�CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
UBC SECTION 109
L' LL IN'P�E.l Cy
"N"i2;INEIR Y..L1'1WA' ES
FAX 10)t?
CATE OFqE*PANCY PAS BEEN GRANTED.
iUvap. 2-191,02-
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