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CONSTRUCTION PERMIT APPLICATION �HUljjAF--_T _SCWLSUITEIAPT#
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L, C_ PUT NAME/SUBDIVISION NO, 1 LOT NO. LID NO,
MAILING ADDRES LID FEE Ir
C'e'-rt, PUBLIC RIGHT OF WAY PER .111cIAL STREET MAI
CITY I ITELEPHONE EXISTING— PROPOSED— slessel"I'ann
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BECLARM DEDICATION— FT Uaesm�
NAME METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO C3
ADDRESS REMARKS
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ITELIPHONE
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NAME
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STATE LICENSE NUMBER X,,_,= VAIANOE OR CU S11011LINE OR AD11 INSIECTI N JPBOND
REO'D OSTED
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PROPERTY TAX ACCOUINWT SEPA REVIEW SIGN AREA HEIGHT
CEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
0 NEW E] RESIDENTIAL 1:1
PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE BEAR FRONT LISSIDE HEAR
ADDITION COMMERCIAL 0 C MPL110E OR
CHANGE OF USE
PARKING LOT AREA I PUNNING REVIEWED BY DATE
REMODEL 0 APARTMENT [3 SIGN REDD PROVIDED
REPAIR GRADING CYDS 0 F114CE
( — X FT) REMARKS
0 DEMOLISH E] TANK 1:1 OTHER
GARAGE RETAINING WALL
CARPORT ROOKERY RENEWAL
OWE OF USE, BUSINESS OR ACTIV" EXPLAIN:
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STORIES UNITS NUMBER Y F AD
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 108/FiNAL INSPECTION REO'D
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VALUATION $
Description
FEE Description FEE
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$:_�MGLAZING
Plan Check
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HEAT SOURCE % LOT SLOPE %
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PLAN CHECK NO: 11STEO DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM - FERS WORK TO
IT C""
ft BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
D OMAIN (CURBS, SIDIAVALKS, DRIVEWAYS MARQUErS, ETC.) WILL REQUIRE
SEPAMTEPERM;SSIOXIL
Engr. Review
City Surcharge
PERMITAPPLICATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERM9 MR MORE INFORMATION
—PLIC ON IIE-UFOF His OR HER IPOUII� HEIII. A15IGNI -0 SUCcU.B.
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
Plan Chk Deposit
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS MOM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
Fire Inspection
Total C15
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 N OR LIMIT IN ANY WAY THE Cpi ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Amount Due
Receipt # Ty
INEREDY 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
APPLIC
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
is lot a planIt until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY NO PERSON WILL BE EMPLOYED
n'tTiet-thefleatio,
ding Offioal or his/he, papery: and Fees am paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR rINSPECTiON
meolpt Is acknmlodg,d in sp— plovIded.
WORKMEN'S COMPENSATIO��NCE AND RCW 18,27,
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SIGNATURE (OWNER E E SIGNED
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71-0220
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A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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ENGINEERING DIVISION DATE —
PLANNING DIVISION D ATE_
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DESCRIPTION OF WORK TO BE INSPECTED_,6_(�'
A field inspection was conducted to determine final 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
___X_GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WIT11 CONDITIONS NOTED
u Copy of CONDITIONS given to owner/contractor by inspector
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
u Copy of CORRECTION NOTICE given to owner/contractorby inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date- Sign_
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Date_ Sign_
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FOUNDATION:
Footing .............
Wall ..........................
Pier/Porch .................
Retaining Wall
Stab Insulation ..........
PLUMBING:
Underground
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HEATING:
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Gas Piping .................
Equipment .................
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EXTERIOR SHEATHING
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NAILING ...............
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FRAMING ......................
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FRAMING
FIRST FLOOR
INSULATION ...................
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Wall Insulation
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY .............. ...
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