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PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JJL,�' p I ��EIAITI
P!_ATNAME/SUBDIVISI ON NO� 101 NO, _�D NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW " I__ 0
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CITY ZIP TELEPHONE
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NAME
YES ci No
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REMARKS
ADDRESS F -A EROSION CONTROUDRAIN�Oiz
ZIP TELEINCIN
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COMPLETE EXEMPT ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.)
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0 ADDITION
C MPLIANCE A
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—
PARKING LOT AREA PLANNING REVIEWED BY DATE
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J20REPAIR C] ..A.W. Y.S
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REMARKS
DEMOLISH C3 TANK
G A Y
A AGE RETAINING WALL
ARPORT E.CKER
RENEWAL
TIVITY) EXPILAIN:
CHECKROBY ITY
OCCUP�-p
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DESCRIBE WORK TO BE DONE--r':,'. _I 0.
I
IIQTEME ILAIINI I LOTSLOPE1
PLAN CHECK N VESTED DATE
I LTHIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
PERMIT AUTHORIZES ON'
0
V
BE DONE N PE, ATE P'O
2 DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
a R I L PER P
A - 1 0
PERMIT LIMIT'. I YEAR, PROVIDED W FIX IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
N ENA F HIS OR HER SPOUSE, HEIRS, ASSIGNS AN CES S
;APPLICANT. ON BEHALF OF
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS T E ITY F
2 EDMOND. WASH NGTON ITS OFFICIALS, EMPLOYEES, ANDAGENTS,FR I -YAM
M C" SFOR M . S LEE ARj�jNQOjREC "I R ADIR TLY
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I ALL LA M DA AGE E F WHATEVER NAT T
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A C M 0
LL M I N PERMIT ISSUANCE 0,
'RO THE -A CE OF T HIS T
E�. T T 'SSU . 0 C NY REQUIREMEN OF ANY CITY ORDINANCE
F EEM T MODIFY W 1 0 � U EA
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ED M WA'V R E
T - 0 Y WAY T Ve CTI E B'L'TY To ENFORCEANYO
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ORMLIM T Y W Y T CITY
0 NOR LI VI NAN HE A ROMANCE PROVISION
REMAR
OGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 3c
Z ;;i;:
Regafdless a! Gthff
Is open or closed emansion tanks are
required on all hot water tanks per
City ;ode.
ECDC 19.30,020 (c)
UATION
FEE
PLAN CHECK FEE
BUILDING
LUMBING
MECHANICAL
GRAD"'O"LL
STATE SURDH—E
ENG. REVIEW FEES
ENG. INSPECTION FEE
'_55� -
Nsw.&�E
PLAN CHECK DEPOSIT
- LAMOUNTOVE
HE F PT
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I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN , CORRECT. AND THAT AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE 0. NO STATE LAWS REGULATING CONSTRUC
5ER JZITYA
1� DjAGR5TEHE0W00MPLYUW1THRC D
TION, AN DING RK A TH ED THEREBY, NO PERSON WILL BE EMPLOYE
0 TO
IN VIOLATION OF THE LABOR CODE 01 THE STATE 01 WAIHINGT N HE ATING
WORKM ENS COMPENSATION_!�.�UURANCE AND RCW 18.27._
CALL
FOR INSPECTION
(425)SI
771-0220
APPLICATION APPROVAL
T
%Op
HE OWNER 0:(LAii
DATE SI
fTED
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
EXT/333
771-0221
FAX
ORIGINAL FILE YELLOW INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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SETBACKS .....................
FOUNDATION:
Footing ......................
wall.................
Pier/Porch .................
Retaining Wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ................ o..
Commercial Final
HEATING:
Gas Test ....................
Gag Piping .................
Equipment...................
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation 7.
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............
-7
... ........
czx) PERMITEXPIRES 517_1�ju j
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CITY OF EDMONDS
USE, PERMIT 2CMcR,
ZON �_s NUMBER
CONSTRUCTION PERMIT APPLICATION
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ADDRESS (9 SU
H"ICATION
PI -AT NAMEISUSDIVISION NO. LOT NO. L No.
MAILINGADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP All,
0
CITY
EXISTING — PROPOSED 0
REQUIRED DEDICATION— FT
NAME
KJA
METER SIZE I LINE SIZE I NO. .1 FIXTURES YEPRV REQUIRED
so No 0 lE
REMARKS
ADDRESS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP ITELEPHONE
ADDRESS
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(TYPE nF$5_Bt,7NESS OR ACTIVITY) EXPLAIN:
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NUMBER DUMBER OF CHIT CAL
WELLING ARV
OF U E NU,
STORIES IN NIT
DESCRIBE WORK TO BE DONE—r-7
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FIRE REVIEWED BY
DATE
VARIANCE OR CU SHORELINE OR ADBN INSPECTION I PbCNE�a
RE 'D DST
E3 YES C3 NO
SEPAREVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PR POSED
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LOT C VERAGE REQUIRED SETBACKS (FT5 PROPOSED SETBACKS (FT.)
ALLOWED PRO-OSED FRONT SIDE REAR FRONT URSIDE REAR
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VALUATION I FEE
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P L A N C
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
-
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NT P -LC
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
G P I,
A
JHE
DOMAIN JCUABS. SIDEWALKESPARIAVEEWAYS, MARQUEES, ETC.) WILL REQUIRE
PERMISSION.
PERMIT APPLICATION: 180 DAYS
TATE SURCHARGE
S T T
G S
PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
EN REVIEW FEES
N. F
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ENG. INSPECTION PEE
,I
S D SUC 0
A A P EA SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
P LICANT. ON BEHALF OF HIS OR H DSUCCESORS
ILEES THE CITY OF
IN NTEREST, AGREES TO INDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
Ih
bA.
�T. 0 N N
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
RISING T G TL Y
ALLCLAIMS FOR DAMAGES OF WHATEVER NATURE,A DIRECTLY OR INDIRECI
N
RECEIPT
1. FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
Y
Y
9 DEEMED TO MODIFY. WAIVE 0 REDUCE ANY REOUIREMENTOF ANY CIT ORDINANCE
NOR LIMIT IN ANYWAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
TOTAL AMOUNT DUE
RE(�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPROVAL
U
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE ULY A THORIZED AGENT OF
Th�!PPLI!ATI�N
1. PI:', I_ , IF— I u.IiI Ig� d by Ih,
LAW
T EOWNER. I AGREE TO COMPLY WITH CITY AND STATE S REGULATING CONSTRUC
H
NO PERSON WILL BE EMPLOYED
CALL
GO �"g ojj,� �j � hjsj��, G.puly' -d F—b
d
TION; AND IN DOING THE WORK AUTHORIZED THEREBY,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTIO N P1 I, ,k ... dged—p... p—d.d.
WORKMENS COMPENSATIO141 AND RCW11,11,
OFFICIALS SIGNATURE DATE
TURE (OWN
(425)
11-2-16-6
('RANCE
771-0220
DATE
A17ENTION
EXT/333
IT IS UNLAWFUL TO USE 08 OCCUPY A BUILDING 08 STRUCTURE UNTIL
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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