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PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE J��512_ NUMBER2DO2 -Coo
CONSTRUCTION PERMIT
APPLICATION
JOB SUITEIAPT#
ADDRESS 0 ('CA:RV-1t'V 0
OWNR3AMEINAME OF BUSINESS
V,
PLAT NAMEISUBDIVISION NO,
I LOT NO,
1111 N
MAILING ADDRESS
LID FEE S
40,9-
Y'
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
a.,. .' I
CITY ZIP
EXISTING — PROPOSED
ITILEPHONE
_r3
REQUIREDDEDIC IONI_ FT
Winn —had 13
NAME
METER SIZE LINE SIZT
PAY REQUIRED
I
YES 13 No E3
ADDRESS
REMARKS
Is
WNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
CITY ZIP
-
ITELIPHO111
1�pe B or L vent connectors
NAME
on fuel -burning appliances in
r
—E—N(
required
it
fifffiftted spaces. UMC 815"VIEWEDIDATB
ADDRESS
FIRE REVIEWED By DATE
CITY
8 iFzj'Pi
TELIP ONE
F I - L/
STATE UCENSE NUMBER
EXPIRATION DATE
D
VAIIIANCE OR CU
SHORELINE OR ADILP
INSR1.10CTION
"ONO
POSTED
OC
.211 b/0
I �m
SERA REVIEW
SIGN AREA
OYES r3NO
HEIGHT
PA.— TAX Acco - CE, No.
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
5 (901313'5'cocac 0 0 n
.. ,
I
I
N Ew
RESIDENTIAL
PLUMBING /MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACK$ (FT.) PROPOSED
FRONT SIDE REAR
SETBACKS (FT.)
FRONT UASIDE REAP.
ADDITION
0 C04MERCLAL
o C MPLIAN E OR
CHANGE OF USE
I I
0 EMODEL
APARTMENT
SIGN
PARKING
D I PROVIDED
LOT AREA
I PLANNING REVIEWED BY DATE
0 REPAIR 0 GRADING CYGR 0 F NICE
( _ X Fri
REMARKS
E] DEMOLISH TANK
0 OTHER
Ei GARAGE A ING WALL
CARPORT 0 REOTCAINERY
[3 RENEWAL
(ME OF USE. BUSINESS OR ACTIT EXPLAft
oe
CHEOKEDBY ITY
S
CF
OCCUFA��
ACTI "NFr
GROU
NUMBER
0,
.T.A.S. +br
NUMBER F
DWELLING
UNITS
I CRITICAL
AREAS
N UMBER
_'/
SPECIAL INSPECT
RE, �UJRED
OCOU NT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REG'D
C-1 I--
Pirm , , -
I
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE %
Building
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
2e
THIS PERMIT AUTHORMS ON' WORK NOTED. THIS PERMIT COVER,; WORK To
HE DONE ON PRIVATE PAO ONLY. AM CONSTRUCTION ONTHE PUBLIC
Grading
Recording Fee
DOMAIN ICURBIS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERMISSION.
PER ITAPPUCATION: ISODAYS
Engr. Review
City Surcharge
PERMIT UMM. I . - PROVIDED WON 19 WART90 WITHIN 1. DAYS
Engt. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
-APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, AS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PEAMM ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINANCE
Fire Inspection
Total Amount Due
NOR LIMA IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapainsp.1
Receipt # 116OLkt
I HERE 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
_
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a pencil until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE so " OF THE STATE OF WASHINGTON RELATING TO
Building Official of hislhlt Dopuly; and Foes paid, and
FOR INSPECTION receipt I, ack—lodged in spa,, pnovided.
WORKMENS COMPENSA�T �N. E All. — 1.21.
AL
OFFICI_Z
;=E (OWNE;��Nn DATE SIGNED
(425)
rp
/
7
771-0220
RELEASED W DATE
�"ATTENTION
EXT 1333
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-
ORIGINAL -FILE YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER GOLD � ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION'
rooting...............
.......... ; ...........
z
Pier/Porch ...........
0
Retaining Wall ...........
M
Stab Insulation ..........
PLUMBING:
ITI
rn
Underground ..........
Rough -In ...................
Commercial Final
A IT!
HEATING:
Gas Test
M3
Gas Piping
Equipmbnt ..........
Commercial Final
0
0
EXTERIOR SHEATHING
NAILING
M C)
FRAMING ...............
FIRST FLOOR FRAMING
INSULATION ...................
z
Floor Insulation
Wall Insulation ...........
0
z
Ceiling Insulation
0
SHEETROCK NAILING
ITI
SPECIAL. INSPECTION