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PERMIT EXPI RES
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
LOT NO, LID ND,
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL
LID FEE S
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CITY b1l C)ITIL
EL)HOAJOS 1� 'D 2'cP)"dNE S 2 9
EXISTING — PROPOSED —
NAME
METER SIZE I LINE SiZ=
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REMARKS I
FOR EROSION CONTR(
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ADDRESS iv LINE AS rl'UNTER S THE BUILDING
FIRE REVIEWED BY DATE
CITY ZIP T111PIIO"E I VARIANCE OR CU I SHORELINE OR ADB# INSPECTI
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY I F.G'
SEPA REVIEW
E3Y"8 13 NO
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE
ALLOWED PROPOSED FRONT SIDE HEAR FRONT URSIDE REAR
OW . PROPO
ADDITION COMMERCIAL
C MPLIANCE OR
CHANGE OF USE
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REPAIR CYOS
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DWELLING AREAS 'PECIALEIDNSPECTOR JAFIEA
UNITS NUMBER REQUIR [] YES
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WORK TO BE DONE 1:
REMARKS
ii� OGRESS INSPECTIONS PER UBC 108/FINALI
F0 k U R N A-C C— 15 060 11 u ii;; '—ai
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WATE�Q K ATGV �1,60W I"
—1 Irequired on all hot water tanks
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Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
M DOMAIN JOURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, AM) WILL REQUIRE
It: SEPARATEPERMISSION.
Engr. Review
PE MITAPPLICATION: INDAYS
PERRIATILBABIYEAR-PROVI ED WORK IS STARTED WITHIN 'M DAYS
Engr. Inspection
State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLI NT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
CA
Traffic Mitigation
Plan Chk Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARML-1 I", 111 11
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMR. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Total Amount Due
q15
0 NORLIMITINA WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Landscapeinsp.
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOW THAT THE INFORMATION
APPLICATION
APPROVAL
AT
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I ACRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
h sIpsdby,h.
This applicstio, is,,os, pemit hfil
TJON; AND IN D WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMP Y
0 G THE � LA PLOYED
IN VIOLATION OF THE "BOA ODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
I
Bull di,Ig Oftldsl ., hiihs, DI ..d F .. ... pid. hit
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WORKMENS COMPENSATION INSURANCE AND RCW 10,27.
DATE
OR AGEPq'
E SIGNED
(425)
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1 �URE
SS"O� 2-
1
771-0220
RELEASED BY /DA7E
AMNTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
L
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
10/1"
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOON13ATION:
Footing ......................
wall ..............
Pier/Porch ...............
RetalnIng Wall ...........
Slab Insulation
PLUMBING:
Underground
Rough -In ...................
Commercial Final
HEATING:,
Gas Test ....................
Gas Piping . .............
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING . .....................
FRAMING ............
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
. .
OCCUPANCY ...............
. .... .....
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