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PERMIT EXPIRE;
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CITY OF EDMONDS NUMEIIER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
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ADDRESS
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OWNER NAMEINAME OF BUSINESS
'NO.
PLAT NAMEISUBDIVISION NO,
MAILING A DRESS LID FEE S
0k) 3 P1 ..r J PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7T11_1PUA1_1-___
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CITY ZIP ITELEPHONE EXISTING — PROPOSED—
'L I/ j C REQUIRED DEDICATION— FT 13
NAME METER SIZE LINE .17 .0. OF FIXTURES MY REQUIRED
tj 14 YES C3 NO E3
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ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP Reiriardiess of whether the water system
ITELEPHONE
is opin or closed, Expansion WAS are
NAME required on all riot water 1anRs per
C_ E S, C�o WUNEED, ipity E)ede. '---BE) 'I9.90.GFftED/DATE
ADDRESS
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CITY ZIP ME
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADS# 1,13.N.
91,1EW"By, STEC
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SEPA REVIEW SIGN AREA HEIGHT
'lot— TAX ACCOUNT IEL NQ COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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REPAIR [3 GRADING GYRD [] ( _ X FT) REMARKS — ---------------
DEMOLISH TANK rl OTHER
GARAGE RETAINING WALL
CARPORT 'KEny RENIEVAL
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NUMBER NUMBER OF I CRITICA
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STORIES NUMBS
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/11FINAL INSPECTION REOVID
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-VALUATION
Description FEE Description FEE
Plan Check
HEAT SOURCE IIIAZING LOT SLOPE Building
PLAN CHECK NO: lumbing
Mechanical
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THIS PERMIT AUTHORIZES ONLY THE WO K NOTED. THIS PERMIT COVERS WORK TO
11 'ON' ON 11111 IMOP11 ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading Recording Fee
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES' ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review City Surcharge 7--
PERMIT APPLICATION: IN DAYS
PERMIT uniur. I ..Pa.... ..Ki. STARTED WITHIN INDAYS Engr, Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF F 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, ITS OFFICIALS, EMPLOYEES, AND AGENTS MOM ANY AND Fire Review Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANC OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT HE Fire Inspection I lbtalAmouniDue I
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR UNIT IN ANY WAY THE CITYS ABILITY TO ENFORCE AW ORDINANCE PROVISION. -
Landscapainsp. Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIft THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, Me THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
OWNER, I AGREE TO COMPLY WIT CITY AND STATE LAWS 11GULAII GO STA appl callon is net a promilt Unlit signed by In.
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CALL
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OM; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EM dine Official or loaths, Dopnoy: and Fees am paid, and
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N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION mooptis, Inimlodgedinar, ... provided,
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WORKMEMS COMPENSATION 114SURANCE AND R 18.27.
WON, CW
OFFICIALS SIGNATURE -DATE
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SIGNATURE IO�Wnlrl Crit DATE SIGNE (425)
771-0220
RELEASED By DATE
A vs,41E.
911 owtv CA 1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 771-0221 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
SETBACK$ .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining W,all, . ...........
Alab Insulation
PLUNiBING:
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Unclargtound ............
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Rough -in ...........
0
0
Commercial Final
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HE'ATING:
ID —i
Gas Test
Gas Piping .................
Equipment.................
Commercial Final
1711 M
0
EXTERIOR SHEATHING
0
NAILING ..........................
0
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FRAMING ........................
IT11
FIRST FLOOR FRAMING
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INSULATION
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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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