20020162.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMFINAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO. LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Tra.P App-,..
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REOLRRED DEDICATION— FF — U—mZe�dea
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METER SIZE I LNE.,;T--[-;;7� —Y.PRV REQUIRED
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PROPERTY TAX ACCOUNT PARCEL NO,
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ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE RSATR
ADDITION
[3 COMMERCIAL
COMPLIANCE a
13 CHANGE OF USE
REMODEL
APARTMENT
0 SIGN
PARKING L, DATE
LOT
REOD PROVIDED
0 REPAIR
GRADING eyes E] FENCE
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REMARKS
AWATER SERVICE SHUT01711
[3 DEMOLISH
TANK
El OTHER
SHAU. RE INSTALLED ON TFIF
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NUMIER
OF
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DESCRIBE WORK TO BE DONE
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PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEM THIS PERMIT COVERS WORK TO
1: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRU.104 .. THE PUBLIC
'a
— —
Grading
Recording Fee
:2 'GUNN (CURBS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERM;$GlOW.
1
EngL RoVieW
PIERMITAPPLICATI N: INDAWS
City Surcharge
PERMITLIMMIYEAr� PROVIDED WORK is STARTED WITHIN I.DAYS
Engr, Inspection
State Surcharge
13EE RACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF 01 his ON IIIR IPOUSE� HEIRS ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS 11,11, ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF MIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 0 E
DEEMED TO MODIFY. WAIVE OR
Fire Inspection
Total Amount Due 1?,-�
REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
21 NORLIM IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
Landscape Insp.
Receipt # --v4 04
I
G
I HEREBY ACKNOWLE GE THAT I HAVE BEAR THIS APPLICATIOPh THAT T14E INFORMATION
—
APPLICATION APPROVAL
GIVEN Is CORRECT, AND T14AT I Am THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE To COMPLY WITH CITY AND STATE LAWS REGULATING CONS MUC
CALL
This appl-m, is net a permit until signed by the
TION; AND IN DOING THE WORK AUTH RIZED THEREBY. NO PERSON WILL BE EMPLOYED
LAUD
IN VIOLATION OF THE R CODE OF THE STATE OF WASHINGfON RELATING TO
FOR INSPECTION
Hint d"It Off;nLat or his/he, Depeny: and Fees am paid, and
'ace pt is ack-Itleged 11 space pm,idod.
WORKMEN'S CqMPENSATIO� URANCE A20 RCW U!27,
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��NS
SI URE SIGNED
(425)
71017
771-0220
RELEASED By DATE
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 08 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:'
Footing ..........
wall.. .......... ... ...........
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Pier/Porch ... ..............
V,
Retaining Wall
0
Stab Insulation,,,.".,
PLUMBING'
Underground .............
Rough -in ... ................
0
Commercial Final
C:
--I
M
M Z
HEATING:
Gas "Test
On
Gas Piping .............
0 -n !,�l
Equipment ...............
n
Commercial Final
M M
0
EXTERIOR SHEATHING
0
NAILING ............. ............
0 IT
C: to
FRAMING ................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
z
SHEPTROCK NAILING
IT
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...............