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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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ADDRESS
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER 20!�SQ5
108
ADDI SQ 7PTI
PI -AT NAMEISUBDIVISION NO. LOT NO, LID N ,
LID FEE S
PUBLIC RIGHT OF WAY PER 011ICIAL STREET MAP
P.- 0
EXISTING — PROPOSED- 00
REQUIRED DEDICATION— FT
E SIZE
"CAT'O
'ZE L'
PRV REOUIRED
-ETER
yes 0 No
REMARKS
OVVNERICONTRACTOR RESPONSIBLE FOR EROSION CONTR.UORAIN 21
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FIRE REVIEWED By
DATE
ONE
-7
Q 7
fTELll
ILI
VARIANCE —OR CU SHORELINE OR ADEN
CEORCU
-INSPECTION I BOND
STATE LICENSE NUMBER EXPIR
ON DATE CHECK DBY
I POSTED
JZO i
SIGN AREA
CYRE...
ES 13 NO
HEIGHT
SERA REVIEW
MPLETE EXEMPT ALLOWED PROPOSED
COMP
ALLOWED PROPOSED
PI EL NO.
,J.�%ACCOUNT PAR
wo It) '7"Of
EXP
XP
LOT COVERAGE REWIRED S.ACKS III
PROPOSED SETBACKS IlT1
NEW RESIDENTIAL
lL...IN I MECH
ALLOWED PROPOSED FRONT SIDE REAR
FRONT UP SIDE REAR
AUDITION COMMERCIAL
_�A E OR
0 CHANGE OF USE
PARKING G REVIEWED
By DATE
C] REMODEL APARTMENT
[] SIGN
REGO I PROVIDED
C] FENCE
-REMARKS
EPAIR
��RGRADING CYOS
( X FT)
DEMOLISH TANK
OTHER
ciGARAGE 0 RETAINIRN�G WALL
CARPORT
C] RENEWAL
(TYPE 0
'��OSS OR A,CTIVIW) EXPLAIN:
C"C"DBY
Occu
GROU
NU
NUMBER- MSER OF
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OCCUPANT
DWELLING
UNTS
A EAS
NUMBER
EQUIRED JAREA
R C3 YES
LOAD
LOT SLOPE %
PLAN CHECK NO: I ...... —
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
m SEPARATE PERMISSION.
t:
PERMIT APPLICATION: 18� DAYS
PERMIT LIMIT'. I YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
w �APPUCANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
!I IN INTEREST, AGREES TO IND5MNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS.WA NGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
SH' L
A R 0 M
LLCUkIMS FO A AGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECT I
FROM THE ISSUANCE OF THiS PERMiT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE A Y REQUIREMENT OF ANY CITY ORDINANCE -
NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
REMA KS
ROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'Dl 41
_FwgArdiaQ�. �'j whtx6ax the wate
is oen or clused, expansion tank; are
required on a!l bot witer tanks
per
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VALUATION
FEE
P AN CHECK FEE
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NG.REVIEW EES
N INSPECTION FEE
INSPEG*CR"PEE
PLAN CHECK DEPOSIT
RECEIPT
TOTAL AMOUNT DUE
R C
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
OW OR THE DULY AUTHORIZED AGENT OF
GIVEN CID YNER.
IS RRECT, AND THAT I AM THE
THE OW ER. I AGFIEETQGoMPLYWIT.Cl AND STATE LAWS REGULATING CONSTRUC
N 'IT
CALL
'HON. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSO WILLBEEMPUDYED
IN CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTI,
VIOLATION OF THE LABOR
1ORK"IN I COMPENSATION INSURANCE AND RCW 11,11
1(7NATUREGPNEJ�,� ) C �
C
AT, ,, ED
D SIGN
1
(425)
771-0220
ATTENTION
EXT1333
IT IS UNL AWFUL 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
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OFFICIALS SjGfjAWRE DATE
ORIGINAL FILE YELLOW - INSPECTOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
S BACKS .....................
ET
FOUNDATION:
Footing ......................
p
wall..........................
Pier/Porch .................
0,
Retaining Wall ...........
0
Slab Insulation
-4
PLUMBING:
rn.
Underground
C C3
M
Rough -In ...................
ot
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Commercial Final
171�
HEATING:
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Gas Test ....................
> —4
Gas Piping ..........
Equipment .................
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commercial Final
M M
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ........................
M 0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
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Wall Insulation ...........
Calling insulation
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SHEETROCK NAILING
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
\rn 'S Q - 1:5 —L--,
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PERMIT
NUMBER
CITY OF EDMONDS
N PERMIT APPLICATION JOB T.
CONSTRUCTIO ADDFE-Q
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OWNE7nMElNA PLAT NAMEISUBDIVISION NO. LOT NO, LID 110*
\K lz�y\. 0 LID FEE 5
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0
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U.. P.— C3
kil— 0
CITY :ISTING — PROPOSED 0
85OUIRED DEDICATION PT
0
o0a IT METER SIZE LINE SIZE NO. OF FIXTURES SQUIRED
PRV
NAME YES C3 NO C3
REMARKS
OWNER/CONTRACTOR RPqPONBISLE FOR EROSION CONTEOLIDRA'NAGE
Bill
0l05Ia-lE:s(713L(o:5 01 11-OID
�pr
.],A��CCOUNT PARCEL NO-
1-nn n12111-It (_�If
0 NEW 'W RESIDENTIAL N4PLUMBING I MECH
0 ADDITION C] COMMERCIAL o COMPLIA CE OR
CHANGE OF USE
1:1 REMODEL C] APARTMENT 0 SIGN
E] FENCE
'�WREPAIR 0 ORAIIII CYDS ( — X FT)
DEMOLISH C3 TA14K o OTHER
GARAGE C] RETAINI WALL C] RENEWAL
CARPORT ROCKE NO
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(_p, 0
,e
'j�rSl 01 ACIIVITYI EXPLA�Ift
NUMBEAr- NUMBEROF A� CAL �JA
OF DWELI ING EAS�
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---.GINEERING REM —DATE
0
FIRE REVIEWED By DATE
m
VAR AN F R H WE OR ADS' "ON
VARIANCE OR CU SHORELINE OR AOBN MSP
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REQ�D OSTED
D NO OBTED
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SEPA REVIEW SIG AREA HEIGHT
S PA I EW SIGN AREA �WE
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COMPLETE EXEMPT AL
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LOT COVERAGE REQUIRED SETBACKS (I
LOT CO
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ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
ALLOWED PROPOSED FRONT SIDE REA
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PARKING LOT AREA PLANNING REVIEWED By DATE
PARKIN. LOT AREA PLANNING BE
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REQUIRED 0 YES
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REMARKS
PROGRESS INSPECTIONS PER UBC 10afFINAL INSPECTION REO'D 3.
z
P
HEAT OURCE G�ZIN6= LOT SLOPE I
PLA ECK NO: v ..... ....
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ION ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCT
3 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS� MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
tt
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT, 1 YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND Suu
IN .NTER,,T=.ETS.TO NDl.11j,4,iFY. DEFEND AND HOLD HARMLESS THE CITY OF
E 'N.S. W W. :T CIALS. EMPLOYEES, AND AGENTS FROM ANY AND
0 ATEVER NATURE. ARISING DIRECTLY OR WDI
ALL CLAIMS FOR DAMAGES OF WH
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CtTY'S ASI LITY TO E N FORCE ANY ORDINANCE PROVISION.
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS ApRpTLH,,ATUOLNY, THAT TIE INF R.ATI.N
GIVEN 1 5 CORRECT. AND THAT I AM THE OWNER 0 D AUTHORIZED AGENT OF -
THEOWNER. I AGREE TO COMPLY WITH CITY AN6 STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
RELATING TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION INSURANCE ANDRCW 16.27.
LNATUR11 DAT
z
VALUATION FEE
LAW CHECK FEE m
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
EE
RECEIPT
p=DEPOSIT
TOTAL AMOUNT DUE R CEI
APPLICATION APPROVAL
Tlil I .IP,, 1.1111.19—byth,
CALL ,puty:,�d Ell. 11, p.ld—d
FOR INSPECTION _ 1111912 llkI,dgld ,space Provided.
D
.111CIAIS
(425)
;_�
I I I _uze-v A ELEAS ED By
.Irj 1312
_ATTEhTION r- A I
E OR OCCUPY A BUILDING OR STRUCTURE UNT11 771-0221
IT IS UNLAWFUL TO US PROVAL OR A CERTIFI- ORIGINAL � FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND AP FAX -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD
5198
z
VALUATION FEE
LAW CHECK FEE m
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL
STATE SURCHARGE
ENG. REVIEW FEES
ENG. INSPECTION FEE
EE
RECEIPT
p=DEPOSIT
TOTAL AMOUNT DUE R CEI
APPLICATION APPROVAL
Tlil I .IP,, 1.1111.19—byth,
CALL ,puty:,�d Ell. 11, p.ld—d
FOR INSPECTION _ 1111912 llkI,dgld ,space Provided.
D
.111CIAIS
(425)
;_�
I I I _uze-v A ELEAS ED By
.Irj 1312
_ATTEhTION r- A I
E OR OCCUPY A BUILDING OR STRUCTURE UNT11 771-0221
IT IS UNLAWFUL TO US PROVAL OR A CERTIFI- ORIGINAL � FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND AP FAX -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD
5198
_ATTEhTION r- A I
E OR OCCUPY A BUILDING OR STRUCTURE UNT11 771-0221
IT IS UNLAWFUL TO US PROVAL OR A CERTIFI- ORIGINAL � FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND AP FAX -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD
5198