20020140.pdfPERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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OWNER Pr�NAME IF 1"111
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PLAT NAMEISUBDWISION NO.
LOT NO** UO NO*
MAILING ADDRESS
LID FEE S
'79,-6-1 Ace,
P BLIC RIGHT OF WAY PER OFFICIAL
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STREET MAP
CITY Zip
EXISTING — PROPOSED—
%,,'ITILEPHONE REQUIRED DEDICATION—
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NAME
PRV REQUIRED
13
YES CI NO E3
REMARKS
[ADDRESS
OWNERICONTRACTOR RESPONSIBLE
FOR EROSION CONT.O.D.I.SE
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STATE LICENSE NUMBER EXPIRAnON DATE 13Y
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P?f0PERTY TAX ACCOUNWT CEL NO.
SEPA REVIEW SIGN AREA HEIGHT
BY
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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0 OTHER
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 10S/FINAL INSPECTION RECTO
-715, C20 0 0
7r�'-4w'l 1�-D" nrp< W,a&m
VALUATION $ 46;��/�)
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FEE
Description
FEE
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HEAT SOURCE G-0 LOT SLOPE %
Building
PLAN CHECK NO: VESTED 04TI
Plumbing
--lMechanical
THIS PERMIT AUTHORgGiS ONLY THE WO K NOTED. THIS PERMIT COVERS WORK To
t: BE COME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON T14E PUBLIC
Grading
Recording Fee
DOMMUN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL. REQUIRE
I
SEPARATE PERMISSION.
Engr. Review
City Surcharge
PERUITAPPLICATION: ISO DAYS
PERMITIAM .1YUR-PR0%N...0RK1S.RTIo.ffHI.
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPILICANNr IN BEHALF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREED To INDEMNIFY. DEFEND AND HOLD HARMLESS T111 CITY .1
Receipt #
EDMONDS WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLMM� FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HALL NOT BE
Fire Review
Total Amount Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ORDINANCE PROVISION.-
Landscapoinsp.
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPRUVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
WITH CITY AND STATE LAWS REGULATING CONSTRUC'
appileation Is not, P-11 Until Signed by the
THE OWNER. I)AGREE TO COMPLY
TION; AND IN DING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
UJIThis
dIng Offlelid ., hisfilh., Depu Y: end Fee. A. need, Ad
IN VIOLA I THE LADD CODE 0 THE STAT OF WASHINGTON RELATING TO
FOR INSPECTION
wedid 1, ,k�tedgedil Spoon pmIded.
W.RRMB; CONIFERS If 1RA AND RCYY 18.27.
"GN URE
OpFtCALS 51 0
] f
1E SIGNED
(425)
71-0220
RELEASED BY
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-
ORIGINAL - FILE - YELLOW . INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
...SETBACKS . ...............
FOUNDATION:
Feeling ......................
wall .............. I ...........
Pier/Porch ............
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Retaining Wall
0
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Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ................
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Commercial Final
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HEATING:
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Gas Test ................
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Gas Piping ..............
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Equipment� .............
Commercial Final
EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ..............
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FIRST FLOOR FRAMING
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INSULATION ...................
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Floor Insulation
Wall Insulation ...........
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Ceiling Insulation
SHEETROCK NAILING
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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