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PERMITEXPIRES Z4/'44I:Ze---
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
USE
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�NAMI OF BUSINESS
PILAT NAMEISUDDIVISION NO.
LOT No
710 NO
Lt. FEE I
M MAILING ADDRESS
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[NAME
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
E.IBTN.— rn.lc�.—
REQUIRED DEDICATION— FT
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METER SIZE I
LINE Sli��
PRY REQUIRED
YES E3 No 13
as
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP ITELEPHONE 11
ITY
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5
IN AT
FIRE REVIEWED BY DATE
"RE REWE ED I
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CITY,,
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0
CA - E
STATE LICENSE NUMBER EXPIRATION DATE
KED BY
OR
VARIANCE OR OU
VARANC
SHORELINE OR A111"
IN.' C T'O
INERPEEOCTION
p
PBOND
OSTED
qCKED.Y
YEE ' No
BE 13 NO
SEPA REVIEW
Ed
COMPLETE EXEMPT
SIGN AREA
ALL
RX
HEICHT
HE T GREG
ALLOWED 'No
IROPEATY TAX ACCOUNT PARCEL NO.
,'5 �5 �/P' 440 4,-,<
P
BIT, ,
E] NEW L
LOT COVEArE
ALLOWED PROPOSED
REQUIRED SETS KS (FT.
SIDE REAR I
PROPOSE ETBAQ�KS (Fr.)
0 .
FRONT USK SID�E REAR
.M OR
ADDITION [3 COMPLIANCE OR
CHANGE OF '.IF
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P R IN.
ARKING
LOT AREA
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REMODEL 0 SIGN
MOT)
HE 'R.V'
�!OVCE.
E C
0 REPAIR [3 GRADING FENCE
CYDS 13 1 x Fr)
Far
DEMOLISH I] TANK 0 OTHER
o GARAGE o RETAINING WALL
CARPORT ROOKERY [3 RENEWAL
TF� �UIUSIIIISS 01 ACT1111Y) EXPLAIN:
CHECKED By
ITYP
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UPAA
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NUMBER OF
WELLING
CR ICAL
AREAS
SPECIAL INSPE �TOR
1 1 4
-
AREA
1
OCCUPANT
TORIES
UNITS
NUMBER
REQUIRED 0 Y.
LOAD
I
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 10S/FINAL INSPECTION REOID
VAWATION $
Description
Plan Check
HEAT SOURCE GLAZING
LOT SLOPE I
!T..)ATE
Building
PLAN CHECK N0-
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORKNOTED. THIS PERMIT COVERS WORK TO]
0 DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
M DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS E ES, ETC.) WILL REQUIRE
Enqr. Review
PERM;MAAGU
SEPARATE SSIO'.
PC MITAPPLICATION: 100DAYS
Engr. Inspection
PERMIT UNIT I YEAR -PROVIDED WORK IS STARTED WITHIN ISIDDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIC , ON BEHALF OF HIS OR HER SPOUS , HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Fire Review
IN INTEGEST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS T14E CITY OF
EDMONDS- WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS Fo DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
If,. Inspection
FROM THE ISSUANCE OF THIS PIRMFI. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HERE 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 INSPECTION
WORKMEN'SEMPENSAT12!4N4RANCE AND RCW 18.27.
DATE SIGNED (425)
1 771-0220
ATTENTION 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. UBC SECTION 109 FAX
10/01
Recording Fee
City Surcharge
SIGN,, Surcharge
Plan Chk Deposit
Receipt #
Total Amou I Due
Receipt#
APPLICATION APPROVAL
,is appi1c,ti- rs,ct a lauralt until Manad by did
,a Official a, tualhar Deputy: and Pass WO Paid. anc
'ac.ipt 1. itclun-luaload In Iras. p—ldini.
A'Pa—ATIfIril DATE
Y —TE
A-2
ORIGINAL - FILE YEUOW - INSPECTOR
PINK � OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
PierlPorch .................
z
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ..........
M
Irg
0
Rough -In . .................
0
Commercial Final
M
HEATING:
ITI
GasTest ....................
Gas Piping
.... .............
20
Equipment .................
Commercial Final
IT1 IT!
0 aj
EXTERIOR SHEATHING
0
NAILING ............. ............
0
FRAMING ................
0)
0
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
0)
Ceiling Insulation
z
SHEETROCK NAILING
0
SPECIAL INSPECTION
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............