20010698.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CITY 7 ZIP ITELEPHONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
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ADDRESS
PERMIT EXPIRES
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ADDRESS
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FLAT NAMEISUBDIVISION NO.
I LOT NO.
LON .
_ LLID FEE 5
PUBLIC RIGHT OFWAY PER 01FICIALSTREET MAP
EXISTING — PROPOSED --
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REQUIRED DEDICATION— IT
PRV REQUIRED
YES E3 NO 13
A MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROIJORAINAGE
REVIEWED/DATE
FIRE REVIEWED By DATE
CITY
ZIP
TELEPHONE
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VARIANCE OR CU
SHORELINE OR ADBO
INSPECTION
STATE LICENSE NUMBER
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SERA REVIEW
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
LOTCOVERAGE
ALLOWED PROPOSED
REOUIREOSETBACKSJFTJ
FRONT SIDE REAR
PROPOSED SETBACKS(".)
FRONT. JR SIDE REAR
0 NEW RESIDENTIAL PLUMBINGIMECH
ADDITION
REMODEL
o COMPL ANCE OR
0 COMMERCIAL CHANGE OF USE
APARTMENT 0 SIGN
�i
—
PARKING I
PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
0 REPAIR
CYDS 0 X FT)
0 DEMOLISH
0 TANK
1�4 GiL-F
oGARAGE
CARPORT
r-1 RETAINING WALL
RENEWA L
(TYPE OF USE. BUSINESS OR k�MPLAIN:
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ITYPEOFCONITRUCTION
ICODE 0 .PANT
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ITUMBER
OF
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NUMBEROF
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U WELLING
NITS 'F5
ITICAL
AR S
NUMBER
rPECIALEZIE.TOR JAREA
E R . C3 YES
OCCUPANT
LOAD
DESCR18E WORK TO BE DONE
...... PER UBC 1081FINAL INSPECTION REO'
VALUATION
FEE
PLAN CHECK EE
GLAZING I LOT SLOPE %
BUILDING
PLAN CHECK NO: TED DATE
I
PLUMBING
PLUMBING
MEC14ANICAL
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
z BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
GRAD)NGIFILL
OMAIN (CURB$, SIDEWALKS, DRIVE WAYS . MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
STATE SURCHARGE
1, PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 18D DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG INSPECTION FEE
;APPLICANT
N NTEREST. AGREES To ;NDE.NIP, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
N
I EDMONDS, WASHINGTON. TS OFFICIALS, EMPLOYEES, AND AGENTS FROM A Y AND
ALL CILAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDI RECTLY
!NSPECTION FEE
WE—CEIFT
Z FRO THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
M
PLAN CHECK DEPOSIT
a Y E
_, DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTO AN CITYOFDINANC -
N09LIMI IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
c T
I I
—
TOTAL AMOUNT DUE
1. 1
IHEFEB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: T14AT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
CONSTRUC
T 1ppI,.l.tl... ln., will ull., 119-d by ill
T POWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
NO PERSON WILL BE EMPLOYED
CALL
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TION AND IN DOING THE WORK AUTHORIZED THEREBY.
IN V1 LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION l,l1kl,.Ildg0dil 18 P1111d8d
WORKMENS COMPENSATION INSURANCE ANDRCW 18.21
I E DATE
SIGNATURE 10 NER AGE I FDATF�SIGNEG, (425)
;41ALS aTUR
771-0220
RELEAS ED By
ATTENTIC6,"'
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLO INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK � OWNER GOLD - ASSESSOR
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PARTIAL APPROVAL
VIOLATION
CORRECTIONS REQUIRED
Pernift Number k LO-70 Owner Li A-S C 1)
Job Address
No lF..'l5?�AMV-,OlVC0LN" I.CONN-f. VVMP3�11T AND MAKE WORK COMPLY
WITH ALL APPLICABLE CITY CODES.
CONSTRUCTION Is NOT IN ACCORDANCE WITH APPROVED PLANS AND PERMIT - STOP WORK.
MAKE WORK COMPLY WITH APPROVED PLANS AND PERMIT OR REMOVE.
STOP WORK - UNTIL AUTHORIZED To CONTINUE By CITY INSPECTOR.
CORRECTIONS LISTED BELOW MUST BE MADE: BEFORE WORK CAN BE APPROVED AND/Olt THE
NEXT PHASE IS STARTED; To AVOID POSTING OF A STOP WORK ORDER, ORDER To
CORRECT, OR ABATEMENT PROCESS.
F-1 JOB CARD MUST BE POSTED ON SITE AND BE VISIBLE FROM STREET.
APPROVED PLANS MUST BE AVAILABLE To INSPECTOR ON SITE.
WORK DESCRIBED BELOW HAS BEEN INSPECTED AND Is APPROVED.
F--j CONTACT INSPECTOR AND ARRANGE FOR APPOINTMENT.
F-1 RECALL FOR INSPECTION.
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14E ACTIONS OR CORRECTIONS INDICATED ABOVE ARE REQUIRED WITHIN
A DAYS OR PENALTIES MAYBE APPLIED. FOR INSPECTIONS CALL 425-771-0220
14B-ilding Division OPlanningDepartment LJ Engineering Department LXire Department
CITY OF EDMONDS
Inspector 7 - / �- - ) _ Date
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
WWI.............. 7 ..........
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ....................
Commercial Final
HEATING:
GasTest ....................
Gas Piping ..........
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING..; .......................
PAI
FRAMING ........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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ADDRESS
MARKS
NERICUNTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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SERA REVIEW
COMPLETE EXEMPT
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_AULOWED PROPOSED
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT. FICEL NO.
-15 �>
Iss ocn) col, C-c�)
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT JA SIDE REAR
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C] NEW 0 RESIDENTIAL PLUMBING I MIECH
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GRADING CYDS 0"
0 REPAIR X
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DEMOLISH [].._TANK 19 OTHER Ta_C:,::�F
2
o2GARAGE C] RETAINING WALL RENEWAL
ARPORT .. F.Y C]
PARKING
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LOTAREA
J���OAEVI-EDBY DATE
ARK
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CHECKEDBY ITYPEORGOtIST!UCTION
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10 STORIES
UMBER
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UN TS
CRITIC AL
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NUMBER
OCTOR,JAREA
SPECIAL 1NSPE
REQUIRED YE9
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO-1
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VALUATION
FEE
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PLAIN CHECK FEE
HEAT SOURCE GLAZING I
LOT SLOPE
BUILDING
0
PLAN CHECK NO:
IVESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2M DOMAIN (CURBS. LKS. DRIVEWAY , MARQUEES. ETC.) WILL REQUIRE
SIDEWA S
SEPARATE PERMISSION.
RADiN.11IL1
STATE SURCHARGE
PE MIT PPLI.ATI.N: TOO DAYS
PERMIT LIMIT. I YEARRIPROVIDED W AXIS STARTED WITHIN 100 DAYS
SEE BACK Oi PINK PERMITOOR MORE INFORMATION
ENG. REVIEW FEES
ENG. INSPECTION FEE
I
in 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
DON%WA1"I11T.11 TS OIFICIALE. E.PL.IEEB. A". AGENTS FROM ANY AND
ALL"". '0A.A. E�10 WHATEVER NATURE. ARISING DIRE CTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS P MIT. ISSUANCE OF THIS PER IT SHALL NOT CBE
Y E
DEEMEOTO MODIFY, WAIVE OR REA CE ANY REOUIREMENT OF ANMCITY ORDINAN
CITY. EDU
01 NOR LIMIT INANYWAYTHE SABILITYTO ENFORCE ANYORDINANCE PROVISION.*
LANDSCAPING
INSPECTION FEE
PLANCHECKDEPOSIT
TOTAL AMOUNT DUE
REC�IPT
t5lQ A72
I HEREBY ACKNOWLEDGE THAT: HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
T EOWNER. IAGREETO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
H
TION; AND IN DaNG THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR COOS OF THE STATE OF WAS.INGTON REI.ATING TO
WORKMEN S COMPENSATION INSURANCE AND RCW 18.27.
APPLIL;AIIUNA L
"�O by 0.
CALL Thi-PP11. "On I ii�!A
, hl�.' D.ply: I,W F.. .. P.M. nd
FOR INSPECTION c.,P,:,..ck111Idged In spaw p,,,d,d.
��IALS I'D TURE DATE
(425) , /,?
/
WNERI�A.�NT��_-
771-0220, 'RELEASE
EXT 1333
ATTENTIC6,-'
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
771-0221
ORIGINAL -FILE - YELLOW- INSPECTOR
FAX PINK - OWNER - GOLD - ASSESSOR