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PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE Op NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEf TO
ADDRESS /
NE OWR NAMEMAME OF BUSINESS C
PLAT NAMEISUBDIVISION NO. LOT O. LIO N0,
p_o TT E21N 'w
LID FEE S
MAILING ADDRESS cPAPP,wsa O
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP p¢gnp gsQuxs¢ ¢
O I LAY P C .F W IVY
EXISTING PROPOSED
CITY ZIP TELEPHONE ¢
REQUIRED DEDICATION FT p
NAME METER SIZE LINE S12E NO- OF FIXTURES PRV REQUIRED
YES ❑ NO 0 —
ADDRESS REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRCNAGE Z.
CITY ZIP
TELEPHONE
NAME
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ADDRESS
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COMPLETE I EXEM
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DESCRIBE WORK TO BE DONE
REMARKS
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DATE
SHORELINE OR ADO# INSPECTION BOND
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SIGN AREA HEIGHT
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REQUIRED SETBACKS(FT) PROPOSED SETBACKS (FT)
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CTIONS PER UBC 108IFINAL INSPECTION RED'
PLAN CHECK FEE
HEAT SOURCE GLAZING% LOT SLO
BUILDING
PLAN CHEC NO: VESTED 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
GRADINGIFILL
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
eSEPARATE PERMISSION.
-tDAiGSURCHARGE
PERMIT APPLICATION: 180 GAYS
PERMIT LIMIT.I YEAR, PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG, REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
END, INSPECTION FEE
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
2 EDMONDS. WASHINGTON,ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
CLAIMSFORDAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR I NOIRECTLY
INSPECTION FEE
iALL
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
PLAN CHECK DEPOSIT
DEEMED TO MOOIFY,WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANYOROINANCE PROVISION:
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
TION, AND IN DOING THE WORKAUTHORIZEDTHEREBY.NOPERSONWILLBEEMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTII
�( IN VIOLATION OF THE BOR LODE OF THE STATE
f� WORKMEN'SC PF 1 INSURANCE AND RCW IB,2J.
TU ENTI DATE SIGNS
(425)
_ // `5 U
771-0220
A I
EXT 333
IT IS UNLAWFUL 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
890
VALUATION FEE
llA •�
1PPLICATION APPROVAL
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FINAL, PROJECT APPROVAL FORM
TO:
DATE: -
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
nN�(\el �nMrQ ENGINEERING DIVISION DATE ( O?
PLANNING DIVISION DATE
PROJECT
SITE ADDRESS IGC l 1 D
PERMIT # "2 ('OBIS ADB#— ,� ``DATE INSPECTE
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DESCRIPTION OF WORK TO BE INSPECTED��g/
A field inspection Was conducted to determine i-mal compliance with approved plans. Final approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
_GRANT FINAL PROJECT APPROVAL
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
❑ Copy of CONDITIONS given to owner/contractor by inspector
1.
FAILED FINAL INSPECTION - OUTSTANDING ISSUES
❑ Copy of CORRECTION NOTICE given to owner/contractor by inspector
1.
2.
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign
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INSPECTOR DATE APPROVED.
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Footing ......................
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.._. Well
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Pler/Porch .................
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Reteinirq Wall .....:..
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Equipment ...... '..:
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- EXTERIOR SHEATHING
.. - NAILING ...::
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FRAMING
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FIRST FLOOR FRAMING...
._ ... INSULATION ...................
....
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. '. .... Weil Insulation ...........
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Ceiling insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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• - MISCELLANEOUS ..........
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FINAL APPROVAL FOR
(, l(%� F/�C. ✓%/ IIiP/oz-
a
9 OCCUPANCY ..................
PATE DECEIVED
PERMIT EXPIRES
USE
PERMIT
CITY OF EDMONDS
ZONE
NUMBER
PERMIT APPLICATION
aoB
SUITEI PTI
CONSTRUCTION
ADDRESS
/
OWNER NAMENAME OF BUSINESS
G
PLAT NAMEISUBDIVISION
NO.
LOT O.
LIDNO.
uD FEES
F
MAILING ADDRESS
PUBLIC RIGHT OF
WAY PER OFFICIAL
STREET MAP
¢cP APP�¢e
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EXISTING
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METER SIZE
LINE SIZE NO.OF FIXTURES
PRV REQUIRED
NAME
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YES ❑ NO 0 Z
ADDRESS
REMARKS B
OWNEMONTPA rnR PF.—NRIBLE FOR EROSION CONTROUORAINAGE
CITY ZIP
TELEPHONEEFI�E
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8
CITY ZIP
Sr rr(! i3%SI
TELEPHONE
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VARIANCEI
STATE LICENSE NUMBER'EXPIRATION D�TE^
CHECKEDBY
DATE
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❑ NEW N RESIDENTIAL ❑ PLUMBING /
LOT COVERAGE
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COMPLIANCE OR
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❑ ADDITION 0 COMMERCIAL ❑ CHANGE OF USE
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PAR (LNG -
REO'D PROVIDED
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—�
NG,REV EWE '. DATE/]�a
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❑ REMODEL ❑ APARTMENT ❑ SIGN
GRADING 0 C�� MT•
❑ REPAIR ❑ CYDS C/ IE'�LYJ•. % a F)
AR VFYpIN•eli- I's"o
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GARAGE
❑ CARPORT ❑ ROCKIF YG WALL ..,❑ RENEWAL
(TYPE OF USE, BUSI ESS OR ACTIVITY) EXPLAIN: �
CHECKED By .TYPE OF CONSTRUCTION COj),E OCCUPANT
Ly 7// OROUP
431
SPECIAL INSPECTOR AREA OCCUPANT
NUMBER - NUMBER OF
CfllTl
OF 2 DWELLING
STORIES lJ"- UNITS
AREAS
NU
LOAD
REQUIRED ❑ YES
(p
5
DESCRIBE WORK TO BE DONE
//��
REMARKS
PROGRESS INSPECTIONS PER UBC iB&FINAL INSPECTION REO'D
,n A,-nJCE /�/f3T Ao,,)s "APPQ Y•Tiklk
I1.
r' !Ja'• ZO//�
CND / / LLl` "i' w/ � �
VALUATION
FEE
PLAN CHECK FEE
HEATSOUPCE GLAZING
BUILDING
r_
'LOT
PLAN CHEC NO: VESTED 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
GRADINGIFILL
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
.iYAiGSUPCHARGE
��•
PERMIT APPLICATION:19 180 DAYS
PERMIT LIMIT:1 YEAR' PROVIDED WORK STARTED WITHIN ISO DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
LANDSCAPING
fIN
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
INSPECTION FEE
ALLCLAIMSFOR DAMAGES OF WHATEVER NATURE.ARISING DIRECTLY OR INDIRECTLY
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TOMODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
PLAN CHECK DEPOSIT
a NOR LIMIT IN ANY WAY THE CITY 'SABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
TOTAL AMOUNT OUE
pECEI T
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This epplicelipn is Pot ¢ pprmii until mgnee by IKe
TMEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
EMPLOYED
CALL
Boo, OXICIAI or hieSlar Deputy: end Fpe¢e,p P¢iE. antl
g
TIM. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILLSE
IN VIOLATION OF THE L BOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
pceipl i¢ acFnpwloegpEin ¢pew prpviepe.
WORKMEN'S CO E 1 INSURANCE AND RCW 113.21.
AIS SIGNATURE DATE
SI U W ENT) GATE SIGNE/V
AAS
(4L5)
(O�FFI
1
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REy�SEO BY DA E i
Ait='JAM4
EXT 333
Y `�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
,.771 �022I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIEL�
ORIGINAL - FILE • YELLOW INSPECTOR /
PINK OWNER • GOLD W ASSESSOR51,8 /yam
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SE TION/109 �/ 1
FAX
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