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USE PERMIT
CITY OF EDMONDS ZONE E�p IN U M B E R )'- A-5
CONSTRUCTION PERMIT APPLICATION JOB BUITEIAPT#
ADDRESS
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FNER NAMEINAME OF BUSINESS 14w -
PLAT NAMEISUBDIVISION No. L�D NO.
MAILIN ADDRESS L D FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP NE EXISTING — PROPOSED.
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RE.UI.EG DEDICATION—
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NAME METER SIZE LINE SIZE NO, OF FIXTURES PAV REQUIRED
YES [3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
C" ZIP ITILE1110111
NAME
--- lice- Q"'Q1 ENGINECRING REVIEWEDIDATE
ADDRESS
"K 2 1 �j FIRE REVIEWED BY DATE
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CITY ZIP TELEPHONE
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VAFUAN.E OR GU >kSHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKElli- POSTED
2
1
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/V,:�'r )2F4 13 ES N.
0
SEPA REVIEW HERGHT
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PROPERTY TAX ACCO PARCEL NQ COMPLETE EXEMPT ALLOWED PROPOSE. ILLOWE. PROP.S0
'700 00/ qO EXP , I
LOT C VERAGE REQUIRED SETBACKS IFT. PROPOSED SETBACKS IFT)
C] NEW 0 RESIDENTIAL [3 PLUMBING / MECH A LOWED PROPOSED FRONT SIDE REAR FRONT L/A SIDE HEAR
C MPLIANCE OR
0 ADDITION fj COMMERCIAL 0 CHANGE OF USE
0 TIT
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PARKING LOT ARIA PLAMNIN
0
0
PROVIDED
PEOr I
11 REMODEL 0 APARTMENT 0 SIGN D
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[3 REPAIR GRADING
1171
CYCE, X Fn REMARKS
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DEMOLISH 0 TANK 0 OTHER
[:1 GARAGE o RETAINING WALL
CARPORT ROCKERY RENEWAL
10
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0
NUMBER
MREOU'RED JL.A.
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0 YES
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DESQUE WObK TO BE DONE -
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0 REMARKS
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PROGRESS INSPECTIONS PER USC 1081FINAL INSPECTION REG'D,
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VALUATION $
VALUATION $
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Description FEE Description FEE
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al 7 Plan Check
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LOT SLOPE% Building
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PLAN CHECK NO. VESTED DATE Plumbing
Mechanical
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EFINUT COVERS WORKTO
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS P'*
t: BE DONE ON PRIVATE PROPERTY ... ANY CO.SmRUCTI.. ON THE PUBLIC Grading Recording Fee
DOMAN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review City Surcharge
PERMITAPPLICATION: 1100DAYS
PERMIT LIUM. I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS Engr. Inspection Stale Surcharge 4
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APILICA ON BEHALF 01 HIS ON HER SPOUSE, 111111, ASSIGNS 1,11. su=11ORS Traffic Mitigation Plan Chk Deposit
IN INTERNSTT. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLE S THE CITY OF
ANY AND Receipt #
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, .0 AGENTS FROM Fire Review
ALL CLAUMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Fire Inspection Total Amount Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUNIEMENT OF ANY CITY ORDINANCE
901
de NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscapainsp. Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICAnON: 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. This.pplieside Is not a permit until signed by me
CALL
in
TION; AND 114 DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 80ding0fiI.I.Imins .1D.p.Iy:.dF.d—P.Id,.nd
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
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WORK OFFIC7LGIRATURE DATE
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T�R OV�NEB 0 AGE NED (425)
A? 771
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�a , RELEASED BY
ATTENTION,/,' FM 1333 -2-1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL - ell,
771-0221 —46"1
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- FINL
1N YELLOW - 14SPECT'OR
.
NK�-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX P! GOLD - ASSESSOR
10101
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing..............
wait ...........
Pier/Porch .................
Retaining Wall I ..........
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Slab Insulation ..........
PLUMBING:
Underground .............
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C:
IT!
Rough -In ...................
0
0
Commercial Final
C:
R11
171 z
HEATING:
GasTest ....................
Gas Piping .................
Equipment
Commercial Final
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EXTERIOR SHEATHING
NAILING ................
0
FRAMING ...........
mo�
FIRST FLOOR FRAMING...
INSULATION
;0.
Floor Insulation
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Wall Insulation ...........
:0
Ceiling Insulation
01
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SHEETROCK NAILING
SPECIAL INSPECTION
R1
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................