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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PERMIT EXPIRES -=-
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED
REGUIREDDEOICATION— FT
EQUIRED
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8 MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY I ZIP ITILEPH011
NAME
ENGINEERING
ADDRESS 1
FIRE REVIEWED By
DATE
CITY
VA RANCE OR CU
SHORELINE OR ADEW
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INSPECTION
C3 YREOD
ES 61140
BOND
1POSTEC
STATE LICENSE NUMBER EXPIRATION DATE
I CHECKED BY
SERA REVIEW
COMPLETE
SIGN AREA
ALLOWED
HEIGHT
ALLOWED =El
PROPERTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOS D SETBACKS (FT.)
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ALLOWED PROPOSED
FRONT SIDE FEAR
FRONT URSIDE REAR
ADDITION
C MPLIANCE OR
CHANGE OF USE
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PARKING
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DATE
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FIE. KS
PAnnRrqq INSPECTIONS PER UBC 1081FINAL INSPECTION RED'
VALUATION I FEE
PLAN CHECK FEE
HE GLAZING I
LOT SLOPE %
BUILDING
bq,
PLAN CHECK NO:
1111TED DATE
U.. E'N.
LGAADINGIFILL
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
TIO H U
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUC NON T EP BLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES ETC.) WILL REQUIRE
SEPARATE PERMISSION.
I ILL
RcHAFG E
STATE SURCHARGE
AT' 'U
PERMIT APPLI CATIo : 18onAYS
'T
DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 1 80 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V EW 5
ENG. REVIEW FEES
El
ENO INSPECTION FEE
U "`S-RS
C'
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
T HE CITY or
IN tNTERE ST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY or
R.. ANY A.-
2 EDMONDS WA HINGTON, ITS OFFICIALS. EMPLOYEES. ANDAGENTS FROM ANY-D
S E
ALLCI-AIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE AN REQUIREMENT OF ANY CITY ORDINANCE
WAY THE CITY S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
NOR LIMIT IN ANY -E Pr-i'-N -
IREFEE
INSPECTION FEE
PLAN CHECK DEPOSIT
RECEIPT
Al
TOTAL AMOUNT DUE
RECE
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I HEREBY ACKNOWLEDGE THAT � HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT 01
COMPLY C
THEOWNER IAGREETO WITH CITY AND STATE LAWS REGULATING CONSTRUC-
T Mp oy D
ION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WIL I L BE EMPLOYED
I F EL T, . To
RELATING TO
N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON]
WORKMEN S COMFENSA��URANCE AND RCW 18.2 ,
CALL
P CT
0 INSPECTION
FO R
(425)
APPLICATION APPROVAL
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p..
OF
nm. I olip
DATE SIGNED
') I
I I I-w—
R Y DATE
..—1
ENTH* EXT 13-5-5
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN IVIADE AND APPR.VAL OR A CE.lIFI- ORIGINAL 'ILI YELLOW NIPECTOR
PINK - OWNER COLD - ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retalnlng Wall ...........
Slab Insulation ..........
PLUMBING:
.............
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Rough -In ...................
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Commercial Final
HEATING:
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Gas Piping .................
Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING
ANSULATION ...................
Floor Insulation
Wall Insulation ...........
Coiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ................
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CITY OF EDMONDS
F CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISURDIVISION NO.
LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING PROPOSED�
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REQUIRED DEDICATION— FT —
METER SIZE
LINE SIZE
�.,OFFIXTURES
PRV REQUIRED
I
I
YES 13 NO 0
R MARKS
nWNERICONTRAC70FI RESPONSIBLE FOR EROSION CONTROIDRAI.A.E
NAME
ENGINEERING REVISWEDIDATE
a ADDRESS
FIRE REVIEWED BY DATE
7ITY Ilp
TELEPHO E
VARIANCE OR CU
5�14�fRAF
INY PIOT
REG
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STATE LICENSE NUMBER — E.PIRATIONDATE
CHECKEDBY
CO SERA REVIEW
MPLETE EXEMPT
SIGN AREA
ALLOWED
I P,GPOS,G_
HEIGHT ED
PROPERTY TAX ACCOUNT PARCEL NO.
0 NEW 0 LUMBINGIMECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT URSIDE REAR
0 ADDITION OMMERCIAL o C MPLIANCEOR
:jESIDENTIAL
CHANGE OF USE
A PARTMENT 0 SIGN
PARKING
'D
REOG
J=D
LOT AM
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0 0 FENCE
EPAIR GRADING CYDS , X
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0 DEMOLISH 0 TANK 0 OTHER
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GARAGE WALL 0 R ENEWAL
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RE ED ..
CCUPA.;
OCCUPAN
LOAD
GESC BEWOR TOSEDONE
=RKS
roPQQ lNQ0FrTInNS PER USC 1011TINAL INSPECTION REG'
VALUATION I FEE
IPLAN
CHECK FEE
HEAT SOURCE
BUILDING
LAN CHECK NO: VIES
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY TH OTED. PERMIT COVERS WORK 10
09 MINE ON PRIVATE PROPERT RUCTION ON THE PUBUC
GRADING/FILL
DOMAIN (CURBS. SIDEWALK RIVE MAR SEE. ETC.) WILL REQUIRE
RATE PER SION.
STATE SU I RCHAFGF
PE PP ATION: AYS
PERMIT LIMIT.- I YEAR P 0 WORK I TARTED WITHIN 180 DAYS
P
SEC SACK 0 PIN IT FOR RE INFORMATION
ENO. INSPECT—
PLICANT. ON BEHALF OF HIS OFIER S E. HERS. ASSIGNS AND SUCCES RE
;A
NPINTEREST. AGREES TO:NDEMNI DeF AND OLD HAIR LESS THE CITY '
LANDSCA PI NO
X E MONDE, WASHINGTON. TS FFICI PL YEES. AND AGENTS FRO ANY AND
c ALLCLAIMSFORDA DES F EV ATURE, ARISING DIRECTL, -----
INSPECTION
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE F THIS PERMIT,SHALL NOT BE
PLAIN CHECK DEPOSIT
DEEMEDTO MODIFY. WAIVE OR REDUCE ANY RE UIREMENI OF ANYC TY ORDINANCE
0 N on LIMIT IN ANYWAY THE CITY'S ABILITY T ENF FICEANY FIDINANCEPROVISION.'
TOTAL AMOUNT DUE
R El
IHEREB ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATI N APPROVAL
AND TFLAT I AM THE OWNER. OR 7 E DILL UT.O.,
GIVEN Y RRECT. IA RIIED AGENT OF
nol a pe-it uol ,gned by IhdO.
CONSTRU�.
THE OWNECRO I AGREE TO QOMPLY WITH CITY AND STATE LAWS REGULATING CONSTAUC
CALL
OM,..[ D.puly: .�d F ... ... P.
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WI ILL BE LEM PLOYED
STATE OF WASHINGTON RE ATING TO
.P Wp P P.
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE
WORKMEN SrOMP Al URANCE AND RCW 18.27,
0 FICIAL SIONATU
I 0/i 0 1
SIG CAT SIGNED
(425)
11!
,�) -:� -1 - --1
14 _7�_
771-0220
FEqEG By
ATTEOTI*
EXT 1333
JTE
ITISUNLAWFULTO USE OR OCCUPY A BUILDING 08 STRUCTURE UNTIL
BEEN MADE AND APPROVAL OR A CERTIFI-
0 RIGINAL - FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK -OWNER GOLD - ASSESSOR
----------
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