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USE PERMIT v
CITY OF EDMONDS
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qpNSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME 0 UStNESS
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PLAT NAMEISUBDIVISION NO.
LOT NO,
U ' No�
I
LID FEE S
MAILING ADDA SS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PAOPOSED�
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NO. OF FIXTURES
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NAME
ADDRESS
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OWNERICONTRACTOR RES�INSIBLE FOR EROSION CONTROUDRAINAGE
CITY
TELEPHONE
NAME
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ow
ENGINEERING E
ADDRESS
FIRE REVIEWED BY DATE
CIT I
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VARIANCE OR CU
E jqat-�� INSPECTION
EOG 0 POSTED
STATE LICENSE N MISER
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N AREA �'o HEI T
T ALLOWED PROPOSED ALIOVVID/ I ZOSEI
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COMP
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o COMPLIANCEOR
AUDITION CHMI NO A
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C] REMODEL SIGN
— COVERAGE
ALLOWED PROP
REQUIRED SETBACKS (FT.)
ED FRONT SIDE FEAR
PROPOSED SETBACKS tFT,)
FRONT UPSIDE REAR
111NAVo 'e,
FIXING
PROVIDED
LOT AREA
PLANNING REVIEWED By I T
'i
FENCE
REPAIR 0 GRADING IYDS I X FT)
0 DEMOLISH 0 TANK
GE 0 RETAKjFgN'fINIALL RENEWAL
[3 CG,.APA.FT
A.0
_,�PE OF USE. BUSINESS OR ACTI EXPLA
CHECKED By ITY
OF TAU TION
OCCUPANT
C 0
FOUP
0
0
NUMBER
STOMES
NUMBER OF
0 SILLING
'2 TS
T CRITICAL
A EAS A
NUMBER
S ECIAL INSPECTOR
RPOUIRED C] YES
AREA OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
DO —9— INQPFICTICNS PER UBC 1081FINAL INSPECTION REG'
PLAN CHECK FEE
SOURCE GLAZING I LOT SLOPE I
BUILDING
PLUMBING
PLAN CHECK NO;�'/
VESTED DATE
MSCHANICAL
THIS PERMIT AUTHORIZES NL1 THE VI NNOYTED I MUPERMIT COVERS WORK To
ULIC
BE DONE ON PRIVATE PRE . A C6NSq "
PER" ON TA CTION ON T EP B
0
GRADINGIFILL
EU
DOMAIN (CURB1. SIDEWALKS, DRIVEWAYS , MARQUEES. ETC.1 WILL A IRE
SEPARATE PERMISSION.
It:
TATE SURCHAR05
END REVIEW FEES
MIT APPLICATION:, 18D DAYS
PER W AT
PERMIT LIMIT'. I YEAR PROVIDED ORK STA ED WITHIN 100 DAYS
IS
SEE BACK Ol� PINK PERMIT FOP. OPEINFORMATION :
- -
-APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
OF
RNG. INSPECTION FEE
N INgERE1T=.ETS TO:NDEMN"Y. DEFEND AND HOLD NARNILESS THE CITY
I I FROM ANYAND
LAN.E.Ap..
III EDM DS.W ON, TS OFFICIALS, EMPLOYEES. AND AGENTS
ALLCLAJMS FOR DAMAGES FWHATEVE-NATU.E.All�l�.�l��IILT�ll.�.'�.�l"
N'F'CT'.N FEE
RECE
I=
FFJ m THE ISSUANCE OF THI S PERMIT. ISSUANCE OF THIS PEANIII SHALL NOT BE
PLAN CHECK D EPOSIT
DEOEMED TO MODIFY. WAIVE OR REDUCE ANY REGUIREMENT OF ANY CITY ORDINANCE
PROVISION **
RE
0 NOR LIMIT IN ANY WAY THE CITY'S ABIL, ry TO ENFORCE ANY ORDINANCE
T TAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
OR THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT. AND THAT I AM THE OWNER.
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTITUC
CALL
TION 5 WORK AUTHORIZED THEAEBY� 40 PER ON- BEEMI ED
S GTOLL 'LOIT
N RE AT NO 0
FOR INSPECTION
IN VIOLK L CODE OF THE STATE OF WAS.IN
INSURANCE AND ROW 16.27�
WORKt ATAR
I I 1
;?
(425)
771-0220
EXT 333
Xff&TION'
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
IT
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
A FINAL
GRANTED. UBC SECTION 109.,
FAX
CATE OF OCCUPANCY HAS BEEN
5,98
0
E EASED BY
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SMACKS.....................
FOUNDATION:
Fooling......................
wall ..........................
Pier/Porch ..................
Retainlrig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
0 IT,
M
Rough -in ...................
commercial Final
x
HEATING:
GasTest ....................
Gas Piping .................
Equipment .............
W
Commercial Final
A
EXTERIOR SHEATHING
(A:
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Coiling insulation
z
SHEETROCK NAILING
SPECIAL INSPECTION
M
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................
ZONE
CITY OF EDMONDS i SUITEJAPTA
,,,TRUCT,ON PERMIT APPLICATION ADDRESS
PLAT NAMEJSUSOIVISIONI NO, LGTNjo
LIO NO,
PUBLIC III AL STREET MAP
LID EE $
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kILINGADDAI(SS
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AME
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ENGINEERING HEYNEWEDMATE
DDRESS
FIRE REVIEWED By DATE
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IfL,IPHONE
VARIANCE OR CU
INSPECTION PBON
EO'D OSTED
0
'TATE LICENSE NUMBER 4DATE CH 0 Y
b
H AREA -L" HEI HT
ALLOWE PROPOSED LOWED, ZPOIED
2S
SERA REVIEW
C Mp T
ERTY ACCOU� PA.RCE I
) 4n5
EXP
c m
m
LO COVERAGE
REQUIRED SETBACKS (FT I
PROPOSED SETBACKS (Ft.)
R:D LL PLUNIT)IN. (ME�.
ALLOWED 1R.1 ED
FRONT SIDE REAR
FRONT URSIDE REAR
NEW
::A
3
11AVV1,9 ,-j4AA
c
COMPLIANCE OR
ADDIT 'A CHANGE OF USE
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PARKING LOT
R P VID D
AREA
PLAN I VIEW—
0 nEMOGeI SIGN
A
GRADING o 1
REPAIR CYDS I — X FT)
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AMrM I
11 TV —
DEMOLISH TANK
O"n
GARAGE (3 RETAINING WALL 0 RENEWAL
CARPORT FIGG�eR
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CHECKEDBY
STRU TION
Occu PANTj�
GROqP
ITYPEOF
M M
-NUMBER—
NUMIEROF
I I�T'.IEA�L
SPECIAL INSPECTOR AREA
OCCUPANT
OF
STORIES
.WELL N.
UNIT.
A� AS
HUM A
REQUIRED E] YES
LOAD
F,
0
DESCRIBE WORK TO BE DONE
REMARKS
OGRESS INSPECTIONS PER UBC JoafFINAL INSPECTION REO'D
r
)AC
Izl_ O_CIEM)Q�=
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0)
VALUATION
FEE
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PLAN CHECK FEE
9
0
m
LOT SLOPE I
BUILDI G
PLUMBING
5e
PLAN CHECK N
MECHANICAL
THIS PERMIT AUTHORIZES ONLY T HE WORK NOTED, THIS PERMIT COVERS WORK TO
LIC
, ONLY ANY CONST N ON 'HE PUe
BEGONE '.. PRTV.T. PRO.T . RUCTIO RE
DOMAIN GURBS. SIDEWALKS A..UEES, ETC.) WILL QUIRE
GRADINGIFILL
TESURCHARGE
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR. PROVIDED WORK IS STARTED WITHIN 160 DAYS
END. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION j
A SSONS AND SUCCESORS
'APPLICANT, ON BEHALF OF H H Rk.
;SMR, NER 'FEO�"DE
jNG`HO THE CITY OF
jNG. INSPECTION FEE
IN INTEREST, AGREES TO t t . OE HARMLESS
NA,,"11FI.MANYAND
LANDSCAPING
INSPECTION FEE
N IT orFIC1ALS.111PLOIES
I
EOMONDS.WASHI IN NG.,RECTLY.RNDReCTLY
ALLCLAIMS FOR OAMA0EiCFWHAT1VER NATURE, AR,�A
RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF TH IS PERMIT SHALL NOT BE
ORDINANCE
PLAN CHECK DEPOSIT
DEEMEOT MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY
0 ROVISION.'
ANY ORDINANCE P
RE
IP
NORLI TIN ANYWAY THE CITYS ABILITY TO ENFORCE
TOTALAMOUNTOUE
E REA APPLICATION. THAT THE INFORMATION
HEREBY ACKNOWLEDGE THAT I HAVT DTH
APP ICATION All R
I F
N IS 1OPREC - AN WNe'RS. OR THE DULY AUTHORIZED ADEN I OF
GIVE D THAI I M'7
Th—P ur
THE "�NR I A.IIE BE EMPLOYED
CALL
F.?
Ad.�
I TLIN. AND IN 00 N THE RK AUTHORIZED THEREBY. NO PERSON WILL
I RELATING TO
OF WASHINGTON
F OR INSPECTION
d d
IN O,_Aj, OF THE LA R CODE OF THE STATE
WoMy C OMPENSAT INSURANCE AND RGW 18.21
0
(425)
771-0220
E EASED BY
EXT 333
TION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
1
771-022 t
INSPECTOR
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
IGINAL- IL YELLOW -
GOLD - ASSESSOR
A FINAL
BEEN GRANTED. UBC SECTION 109.,
FAX
PINK, OWNER
CATE OF OCCUPANCY HAS