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F EDMONDS
CITY OF EDMONDS
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NUMBER
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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PUBLIC RIGHT OF
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ALLOWED I PROPOSED
REOUIRED SETBACKS 'Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (I'L)
FRONT ILIA SIDE REAR
LOT AREA
PINNING REVIEW By
DATE
REMARKS
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CHECKED BY CODE
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SPECIAL INSPECTOR
REQUIRED 13 YE
AREA
OCCIPAN I
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
PLAIN CHECK FEE
DUILDING
HEAT SOUACE:
GLA"", %
7—
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRA01NWFILL
Any construction on the public domain (curb-, sidewolks.
—
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
Application: ISO Days
STORM DnAINAG E FEE
p:Rmit
milt Limit: I year - Provided Work Is Started W Lthn'— 0 'a
..Appllcorij�On beha Ig1IS he's DUST and
0 or P
.0. INSPECTION FEE
a assor. riare,�! A rise to ind.m nif;. defend and hold
UCC is its official
City of Edmonds, Washington. 'i
Re- V/
h rhileSS the
a
employees. and agents from any and all claims for damages 0
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Indirectly from In. I L.nce
or
City d
whatever nature, arisin! dire, be to
PLAN CHECK DEPOSIT
A,
of this permit. issuance . his Permit hall not earned
modify. waive or reduce any - requ! rement of any city ordinance
x nor limit i� any way the City a ability to enforce any ordinance
TOTAL AMOUNT DUE
/�,?17_
.,.Vision.
I hereby acknow!edge that I have read jhIjsh:ppIic:jrIon; that the
ATTENTION
APPLICATION APPROVAL
informal ion given is Correct. nd that I am I own , or the duly
authorized agent of the owZ. I agree to comply with city and
IN'S 1E-V11
This application is not a permit until
state laws regulating conStriuction; and in doing the work authoriz.
AUTHORIZES
ONLY THE
signed by the Building Official or his/her
ad ereby, no person w 1. a employed in violation of the Labor
in 11
Compensa-
I1O.A NOTED
Deputy:, and fees are paid. and receipt is
Code of the State of ashington r�laling to Workmen's
L%MW
acknow edged in space provided.
I ii insurance 9 34 27.
SIGNATURE IOWN7 ATE SIGNED
INSPECTION
DEPARTMENT
OFF A NATU T
CITY OF
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01
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EDMONDS
ME
CALL FOR
D h1E
ATTENTION
INSPECTION
IT S UNLAWFUL TO USE OR OCCUPY A BUILDING R 5 'u RE
FINAL INSPECTION HAS EIEEN MADE AND0APFTDV`ATLuO,
771 - 022 0
OR GINAL E YELLOW— InfPeclor
UN711. A
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
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FINmL PROJECT APPROVAL � JRM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION E,
FROM: —FIRE DEPARTMENT DATE—E
ENGINEERING DIVISION DATE —
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PLANNING DIVISION DATE-
PROJECTS_[-�/U__�_/-
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SITE
PERMIT #5:��C) &I ADB#_____--PATF INSPECTED —0 2—
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine final compliance with appr oved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFO E BONDS and the granting of
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>�- GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WrITI CONDITIONS NOTED
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a Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION OUTSTANDING ISSUES
c3 Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE-INSpECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date___ Sign--,
ocaprvi.dGc.l;tenip:bldg:fornisIO/OI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall .......................
0,
PlerRorch .............
RetainingWall ............
�p
Slab Insulation ............
PLUMBING -
Underground .............
TR
Fough-In .............
Commercial Final ........
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HEATING:
GasTest ...... ..........
GasP[ping ............
Equipment ................
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Commercial Final .........
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EXTERIOR SHEATHING
C (A;
NAILING ....................
FRAMING ............. ......
INSULATION:
FloorInsulatlon ...........
Wall Insulation ...........
Ceiling Insulation .........
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SHEETROCK NAILING ...... .
....
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SPECAUNSPECTION ......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY ......
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CITY OF EDMONDS z-"E
CONSTRUCTION PERMIT APPLICATION [jo-9
IWRMIT
15— NUMBER
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER —SIZE
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;�,,7,,J�LEPHONE NUMBER
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NUMBER A I EXPIRATION
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T.. Account
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F� PLUMBINGAIECH
ADDITION
C MPUANCEOR
CHANGE OF USE
DREMODEL
SIG.
Ej REPAIR
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CIDS
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1—. �F
DEMOLISH
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11 POOL
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[I "T TU.1SPA
G CA AGE
AARPORT
R AININGWALIJ
ROCKERY
RENEWAL
7yPE OF —USE. BUSINESS O� ACTIVITY) EXPLAIN.
NUMBER 1�� I NUMBER 01 9
OF DWELLING
a STORIES UNITS
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AR S
NUMBER
DESCRIOEIOIITO.E�.�E�AT-��lL��lL��I
IENGINEERING MEMO DATED n— I I
FIRE MEJO DAT
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VARIANCE OR CU
SEPA REVIEW
COMPLETE I �XEMPT
EXP
SIGN
ALLOWED
AREA
I PROPOSED
ALLOWED
—POSED
JPFIOPOIED
LOT COVERAGE
REQUINED5ETBACKS ("T I
FRONT SIDE REAR
FRO SETBACKS FT)
FRONT UTISIDE FEAR
LOT AREA
PILANNINGREVIEWBY
DATE
REMARKS
V
CHECKED BY UUF
[7/z - fZ2
SPECIAL INSPECTOR I
REOUIRED CI YES
ARIA
LDCUPANT1
loc AD
MARKS
PROGRESS INSPECTIONS PER LIBC 108
FINAL INSPECT79XIMME80
U55 I = W
PI -AN CHECK FEE
%
I G
PLUMBING
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Plan Check No.
P I a n C
R A L
MECHANICAL
E A N I
N L y
This Perm I I covers work to be done on private property ONLY.
T h P r m
IN
GRADINGIFILL
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k a
Any Construction on tho public domain (curte, sldewplks,
A n y 0 n
0 n
driveways, marquees, etc.) will require separate permission.
d v a w a
A
STATE SURCHARGE
STATE S
P.`mIt Application: 180 Day. I �
P PRIT P
I N A G E F
STORM DRAINAGE FEE
A
L
Permit Limit: I Year - Provided Work 1, Started Within 180 Days
P Prin L
n
A P p I on behalf Of his or her spouse, heirs, assigns a,,,d
d
N E E
&r.ftECT,ON FEE
IN
d
d
su"Applicant,
d IT
ccesSols in interest, agrees to indemnity, defend and ho
S u c
I c
the Cit dn"I'Doe -a I gton. its officials,
S
harmless
h
and ag' ' iE ClIn
j am oyeas e,ls m P, �nd .1i Inns for damages
a m P y a
of
to
E E T
PLAN CHECK DEPOSIT
PLAN CH
u n C
whatever nature,arlaing directly or indirectly from the issuance
W I V
a d
of this permit. I suance of this permit !Mall not be deemed
" t 'I's P
a
n a D
m 0 d any city ordinance
modify,
I 'y' w
or reduce any requireman t Zorce
walve
,in. PC
nor limit n any way the City's ability to an any ordinance
I I
n ' I - I
.
a
OU T DUE
TOTAL AMOUNT DUE
T.TA L A
IL
provision,"
I hereby acknowledge that I have read thlshappilcation; that the
ATTENTION
N I
APPLICATION APPROVAL
th 1 a
information given I, correct; and at PR a owner, or the dUy
uthorized agent of the owner. I agree to comply with city and
a a ,
TRIS PERMIT
This application IS not a permit until
'late laws regulating construction; and in doing the work authoriz
,,.I laws ri� . , 0 r
AUTHORIZE `
T E
signed by the Building Official or his/her
ad thereby. no person will be employed III violation of the Labor
ad
WONLY
OR. NOTED
RK N GTE .
Deputy; and fees are paid. and receipt is
.P. a
Codeof the Stateof V)iashlng,.�,71.,,�.,.-o,�-.n'.Compon�a.-
acknowledged in Space provided.
tion insurance aNq1DW
S—E
BINSPECTION
O'P.FT.EH'
E
SIGNATURE (OWNER A PG
C ITY OF
OFFICIA NAIL IAI
3
EDMONDS
ME
CALL FOR
E— ZE
ATTENTION
INSPECTION
714
IT IS UNLAWFUL TO USTE,OONR .0gCUPy A MAI.LGING OR STRUCTLI PIE
A FINAL INSPE, BEEN AND APPROVAL OR
771-022 0
�OMGINAL — Fde YEI I C)d — 14POrtr
UNTIL BE
A CERTIFICATE OF OCCUPANCY HAS EEN GRANTED. USC
SECTION 109
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