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PERMITEXPIRES
CITY OF EDMONDS
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UA PERMITRI
UM. M
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDREv�p
OWNS NAMETNAME OF BUSINESS
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PLAT NAMEISUDDIVISION NO,
LOT NO,
LID NO.
11. FEE I
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED.
REQUIRED DEDICATION— FT
TES
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CITY ZIP
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ITELEPHONE
NAME
METER SIZE
LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
I
YES C3 NO E3
ADDR'ESS
OWNEFUCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE
-7 75' M-6
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ENGINEERING
REVIEWEDIDATE
ADDRESS
NIE-
FIRE REVIEWED By
DATE
CITY ZIP
L'6 0,
TELEPHO
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STATE LICENSE NUMBER L EXPIRATION DATE �
CH7D BY
VARIANCE OR CU
SHORELINE OR ADD#
INSPECTION
Y REGO No
E3 BE E3
I PEOND
OSTEC
SEPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
2 -3 2 -7 -0'3 0-7 q - C700 -7
NEW RESIDENTIAL PLUMBING I MECH
Cc "PLIANCE 0 R
0 ADDITION fX. COMMERCIAL COMPLIANCE OR
BE 0, US E
CHANGE OF USE
C HAN
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0 REMODEL APARTMENT 0 SIGN
FEND
0 REPAIR 0 GRADING CYGE 0 F NCE
FTI
I X FIT
I _ X
OT. E.
DEMOLISH TANK [11 OTHER
o GARAGE RETAINING WALL
RENEWAL
CARPORT ROOKERY RENEWAL
LOT CO STAGE
ALLOWED VPROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE HEAR
I
PROPOSED S TBACKS(FT)
FRONT URESIDE BEAR
PARKING
REO'D
I
I PROVIDED
I
LOT AREA
PLANNING REVA9. BY DATE
REMARKS
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(TYPE OF USE, BUS=AOTW ",,,,,EXPL,,AIN:
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NUMBER
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REA
—OCCUPANT
LOAD
DESCRIBE'468K TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 11081FINAL INSPECTION REO`C
C_ b-� L_
FEE
Plan Check
HEAT SOURCE
(2:`
LOT SLOPE %
a G
Building
PLAN CHECK NO:
VESTED DATE
4WORKTO
Plumbing
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS
BE DONS ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
�r A
r I g
Grading
G W. REOUI E
I "RE.U.B.
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATI
PEFIMITILIMmIYEAR - PROVIDED WOONISISNTADIAT"FS6 WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT ON BEHALF 01 HIS ON HER SPOUSE. HEIRI. ASSIGNS AND SUcCESORB
Tralli. Mitigation
IN INTEREST. AGREES 10 INDEMNIFY, DEFEND AND HOLD HAHMLESI THE CITY 01
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVEG NATURE ARISING DIRECTLY 08 INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANC� OF THIS PERMIT SHALL NOT BE
Fire Inspection
P9
9EeMED To MOD'FYWAIVE OR RE UCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Cz NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
Landscapolnsp.
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 WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTR
Y(ORKMENS COMPENSATI��IJMNCE AND RCW 18.27.
S1 ATUR it HER A
(425)
1 771-0220
A'11ENTION
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBG SECTION 109
FAX
10101
JAE=
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
APPLICATION APP
This appil,nion is not a P—h-11
PId.d.
1A
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..............
FOUNDATION:
Footing ......................
Wall ......................
Pier/Porch ... . ............
Retaining Wall
Stab Insulation
PLUMBING:
Underground ..........
Rough -in ..................
Commercial Final
HEATING:
Gas Test
Gas Piping
Equipment ...........
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ............
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Coiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
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