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I I-PERIMITEXPIRES
CITY OF
US' PERMIT -Z
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EDMONDS
NUMBER 'I�
CONSTRUCTION PERMIT APPLICATION
JO SUITEIAPT#
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R NAMEMME 0 BUSINESS T-..—
FLAT NAMEISUBDIVISION NO.
T"7
LID NO.
I.M.E.
MAILING BESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
S.—InA.q..
Fi
CITY Ine
EXISTING — PROPOSED
ITILEP"INE
-7 -1 t
REQUIRED DEDICATION— FT
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NAME
METER SIZE
LINE SIZW_r_��
PRY REQUIRED
I
YE. C3 NO E3
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDMNAGE
ZIP
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FIRE REVIEWED BY DATE 1.
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STATE LICENSE NUMBER EXPIRATION
VARIANCE OR OU
SHORELINE OR ADB#
INSPEC�ION
REG D
NO
OBTED
I P10
(3YES [3NO
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
'!CTCrE1061 W�)
E] N EW RESIDENTIAL PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
REOUIRED SETBACKS (FT.)
FRONT SIDE HEAR
PROPOSED SETBACKS JFT.)
FRONT URSIDE BEAR
0 ADDITION COMMERCIAL C MPLIAN E OR
0 ANGE OF USE
EMODIEL APARTMENT SIGN
04
ARKING
REOD' I PROVIDED 17
EA
PLANNING REVIEWED BY DATE
0 REPAIR GRADING CyGS F NCE
( _X_Fr)
REMARKS
[3 DEMOLISH TANK OTHER
ETAINING
n CGARAGE o R WALL RENEWAL
ARPORT -ROCKERY
UYIPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY
ITYPE OF CONSTRUCTIO
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"UMBER IF
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UNTS
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AREAS
NUMBER
SPECIAL INSPECTOR JAREA
OURRED
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OCCUPANT
LOAD
DESCRIBE WORK TO HE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOD
6 I/N A I
VALLIATION $
-
Building
PLAN CHECK NO:
A T
V11TIO DATE
T E
Plumbing
Mechanical
or
K
THIS PERMIT AUTHORIZES ONLY THE AD K NOTED. THIS PERMIT COVERS WORK TO
W
M C I To
S 0
it: US DONE 01 Pill PROPERTY ONLY. ANY .11STRUCTIO. 0. -B PUBUC
0 T U C
Grading
U
IBOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC�) WILL REQUIRE
Engr. Review
SEPARATEPERMISSION.
PERIAITAPPLICAXION: INDAYS
Engr. inspection
IN A
PERMIT LURE I YEAR - PROVID D WORK IS STARTED WITHIN 160DAYS
a. -
0 u'll
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
1
B BE
'AIPPLICANT ON BEHALF OF HIS OR HER SPOUSE , HEIRS, ASSIGNS AND SUCCESORS
I OF
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
N No
DMONDS. WASHINGTON. ITS OFFICIALS, E LOYEES, AND AGENTS FROM ANY AND
E MP Fir
I TLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
V A,
ire rispeothm
BE
FROM THE ISSUANCE OF THIS PERMFT. ISSUANCE OF T141S PERMIT SHALL NOT BE
To MODIFY. NA C
DEEMED WA OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Ox NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
Landscapoinsp.
I HERE ACKNOWLEDGE THAT I HAVE READ TH S APPLICATION; THAT THE INFORMATION
I'
i
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 THOMIZED THEREBY NO PERSON WILL BE EMPLOYED
IN VIOLAT G. OF THE STATE OF WASHINGTON RELATING TO
ION OF THE
FOR INSPECT14
WORKMEN 3 NSIUI CE AND RCW 18.27.
E. r
DATE SIGNED
(OWN::�
(425)
_91GRATURE
�ENT)'
J), "3
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
10/04
Fim
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
This appl
d'ng og��tnuls. I.— a ponelt until signed by But
ule.1p, uili.kno,hulaed In spou pee,dded.
;V[A
'gr DATE
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PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..............
FOUNDATION:
Footing ......................
wall.., .......................
Pler/Porch .................
z
Retaining Wall ...........
M
Slab Insulation ..........
n
PLUMBING:
v
Underground .............
1771
Rough -in
M
0
...................
Commercial Final
C
HEATING:
M
10
GasTest ....................
Gas Piping .................
CA
1
Equipment
n
Commercial Final
M M
EXTERIOR SHEATHING
0
NAILING .................
0
FRAMING ........................
ITI 0
FIRST FLOOR FRAMING
INSULATIO ...........
Floor Insulation
z
Wall Insulation ...........
Ceiling Insulation
z
SHEETROCK NAILING
9
0
SPECIAL INSPECTION
IT
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...........