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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BU INESS
MAILING ABDO SS
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ADDRESS
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CITY ZIP
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
00 7-57�' 2 Ci>- 1 00 -7
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NEW RESIDENTIAL
0 LUMBING I MECH
ADDITION COMMERCIAL
o C MPLIANCE OR
CHANGE OF USE
REMODEL APARTMENT
SIGN
0 REPAIR E3 GRADING CYBR FENCE
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0 DEMOLISH 0 TANK
OTHER
o GARAGE [3 RETAINING WALL
CARPORT ROOKERY RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
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OF
STORIES
.WELL NO
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DES21SE WORK TO BE DONE
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7/ PERMIT EXPIRES
US' E PERMIT
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NUMBER
JOB SUITFJAPT#
ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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METER SIZE
LINE SIZE
PAV REQUIRED
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LEMARKS
3WNERICONTAACTOR RESPONSIBLE FOR EROSION C014TROLIDMINAGE
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HEAT SOURCE BLAZING LOT SLOPE 56 Building M
PLAN CHECK NO: TED DATE Plumbing
FIRE REVIEWED BY
DATE
CIYES E3NO
SERA REVIEW SIGN AREA HEIGHT
-COMPLETE , EXEMPT ALLOWED FROPOIED ALLOWED , 1BOP01111
P
LOT C VERAGE REQUIRED SETBACKS (171 PROPOSED SETBACKS IFT.)
ALLOWED PROPOSED FRONT SIDE BEAR FRONT UR SIDE REAR
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
CHECKEDBY ITYP
SPECIAL INSPECTOI
REQUIRED 0 YES
VALUATION $ /// Yj
FEE
Plan Check I
9
191
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mechanical
THIS PERMIT AUTHORIZIES THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
Grading
Recording Fee
00111111" (CURBS. SIDEWALKS, DRIVEWAYS "ROBBER, ETC.) WILL EQUOLE
R
L sEPARATEPrnuisSION.
Engr. Review
City Surcharge Z/
PERMITAPPLICATION; IN DAYS
PERMIT LIMIT., I - PROVIDED WORK IS STARTED WITHIN VIDDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge _5�
*APPLI AMT. ON BEHALF F His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
"affio Mitigation
Traffic Mitigation
Plan Chk Deposit
IN INWTEREST, AGREES INDEMNIFY, DEFEND AND HOLD HARMLESS THE C17Y OF
WA
2 EDMONDS, SHINGTON. ITS OFFICIALS, EMPLOYEES� AND AGENTS FROM ANY AND
Fire Review
—
Receipt
IA DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROCWTHIESIFOSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DIEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF YCRYORDINANCE
I
re Inspection
'..P..,.On
rds.a
Total Amount Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO E14FORCE ANY ORDINANCE PROVISION.-
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DO
I HEREBY ACKNOWLED E THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPUCATION APPROVAL
GIVEN IS CORRECT, AND THAI I AM THE OWNER, on THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
This application 1--pireeft-til signed byUh,
THIN; AND IN DOING THE WGAA6A.TH..UT..ErHEA.TE�-b.. Is SON WILL BE EMPLOYED
C LL
CALL
Building Official,r his/her Deputy: and The, are paid, and
IN VIOLATION OF THW . 0, OT , WASHINGTON RELATING TO
FOR INSPECTION
receipt I—knowladepod 1, space pmIded.
WORKMEN'S OMPEN IN9URAN E AND RCW $B.27.
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RAN
�Off 1 6 GN R DATE
SIG UBE OWNS R C
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REL Y I BASS
WftENTION
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 COLD - ASSESSOR
10101
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..................
wall ..........
Pier/Porch .............
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Retaining Wall ...........
0
Slab Insulation
PLUMBING:
Underground ...........
0
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Rough -in
M 0
0
Commercial Final
Or
06
HEATING:
M
GasTest ....................
C
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Gas Piping
Equipment
0
Commercial Final
M M
EXTERIOR SHEATHING
NAILING ........... ; ............
0
o Fn
FRAMING ...................
FIRST FLOOR FRAMING
M 0
INSULATION ...................
Floor Insulation
Wall Insulation
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Coiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
ITI
MISCELLANEOUS
FINAL APPROVAL FOR
P0
OCCUPANCY ..................