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PERMIT EXPIRES=
CITY OF
USE
PERM T
EDMONDS
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
SU APT#
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7?�
PLAT NAMEISUBDIVISION No.
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LOT NO.
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PUBLIC RIGHT OF WAY PER OFFIC AL STREET MAP
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CITY
EXISTING — PROPOSED—
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ITELEPHONE
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REQUIRED DE.ICATI.aI_
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NAME
MOCR size
LINE SIZE
NO. 01 FI1TU111
RV REQUIRED
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—ZO—DRESS
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WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAiNAGE
CITY ZIP JTILEIHOIII
NAME
ENGINEERING
REVIEWED/DATE
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DATE
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STATE LICENSE NUMBER
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INSPEC!ION
R ED.
11.1TED.
1,10
Mmm
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$EPA REVIEW
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT DEL NO.
COMPLETE EXEMPT ALLOWED
PROPOSED
ALLOWED PROPOSED
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FRONT SIDE REAR
FRONT URSIDE BEAR
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ADDITION
COMMERCIAL
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0 CHANGE "OF USE
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0 APARTMENT
0 SIGN
PARKING
REGO
I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
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REPAIR [3 GRADING Was [3 F NCE Fn
( FT)
REMARKS
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CAR BY ci RETAINING WALL
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ARPO ROOKERY 0 RENEWAL,
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PECIALEINSPECTOR
OCCUPANT
STORIES
UNITS'
NUMBER
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[] YES
LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaO
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VALUATION $
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Description
FEE
Description
FEE
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Plan Check
--WEAT SOURCE GLAZING
LOT SLOPE %
Building
0
m
PLAN CHECK NO:
VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
t:
BEDONEOMPIRWATEP OPEFM ONLY. AW CONSTRUCTION ONTHE PUBUC
Grading
Recording Fee
DONUIRII (CLIFISS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REQUIRE
SFPARAFE PERMISSION.
Engr. Review
City Surcharge
PERMITAPPUCATION: INDAYS
PERMIT LAMM, I YEAR -PROVIDED WORK IS STARTED WITHIN ISG DAYS
SEE BACK OF PINK PERMIT MR MORE INFORMATION
Engr. inspection
State Surcharge
—IC . ON BEHALF 01 HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGIIES TO INIEMNIFY, D111110 AND HOLD HARMLESS THE CITY OF
Receipt #
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS MOM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire Review
FROM THE ISSUANCE OF THIS PERNIK ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE Oil REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Aniotint Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
andscape Inspi.
Receipt #
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT., AND THAT I AM THE OWNER OR THE DULY AUTHORIZED AGENT OF
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
n -aliI.Ignedby9n,
lan—PaInk
TIORi AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL SE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
BanThf-ppliorel.
ding Official or hisiber Barney: add F000 ate paid, and
—.1p, I—k—ledg.al I -Poe. pid.d.
WORKMENIS COMPENS 1 1 �27.
ea
OFFICI
IS; RE (OWNER G
DATE SIGNED
(425)
7 71
-0220
EIVOSE. BY 'DAnf
TTENTION
M 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 - GOLD ASSESSOR
.7
"A
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
Footing......................
wall ..........................
Pier/Porch .................
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Retaining Will
25
Slab Insulation
PLUMBING:
Underground
M
C.
Rough -in ............
0
0,
Commercial Final
HEATING:
IT
ITI
Gas Test ................
> z
Gas Piping .................
03
Equipment ............
0,
Commercial Final
3: r
EXTERIOR SHEATHING
IT! M
a
0
NAILING ..........................
0
FRAMING ........................
C
K
IT 0
FIRST FLOOR FRAMING
z
INSULATION ...................
Floor Insulation
—4
z
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
z
0
SPECIAL INSPECTION
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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