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CITY OF EDMONDS
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PERMIT
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NUMBER Z1__1;/
CONSTRUCTION PERMIT APPLICATION
'AOBFIE1S ;0/
01 Bull:
2MAMEINAME
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PLAT NAME/SUBDIVISION NO.
LOT No� LH) NO,
MAILI 0 ADDRESS
Lt. FEE I
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
CITY TELEPR;TE
NAME
EXISTING— PROPOSED
REOUIRED INDICATION—
—
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METER SIZE I LINE Bill
I NO, 01 "XTURI!S YEIR�RE.UIOAED
1 .5 N C3
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROLORAINAGE
CITY
ol�
'CIT—Y
FIRE REVIEWED .1 DATE
ZIP
TELEP ONE
if J�
EXPIRAT N DATE HECKED
8
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTI N
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BOND
POSTED
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E3YES 13NO
PROP cc PARCEL NO.
SEPA REVIEW
COMPLETE E11111T
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
,
0 NEW
LOT COVERAGE
REQUIRED SETBACKS IFT) PROPOSED
SETBACKS (FT.)
PLUMBING I MECH
ALLOWED PROPOSED
FRONT SIDE HEAR
FRONT URSIDE REAR
�D N
o C MPLIANCE OR
0 ANGE OF USE
HE NOBEL
0 SIGN
PARKING
RECID I PROV
LOT AREA
P NNING REVIEWED BY DATE
REPAIR
GRADING
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OYDS
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REMARKS
DEMOLISH 0 TANK
E] OTHER
[3 CGARAGE STAIR No WALL 0 RENEWAL
PC R
AR FIT 13 ROOKERY
aYPE OF USE, BUSINESS O=PLAIN:
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DESCRIBE WORK TO BE DONE
-REMARKS
PROGRESS INSPECTIONS PER USC 10S/FINAL INSPECTION RIEWD
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VALUATIONS 5C)U
Description FEE Description FEE,
De"Crip Ion
Plan Check
Plan Check
;DATI rP'UMb,2ngt
GLAZING Is LOT SLOPE %
Building
SU'Idm
3d_ S _j6��
PLAN CHECK NO: I STED
Mechanical
THIS PERMIT AUTHORIZES ONLY THE ORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERT)f ONLY. ANY CONSTIR CTJONONTHEPUBLIC
Grading
Recording Fee
:3 VOIRAIN (CURINI, SIDEWALKS, DRIVEWAYS MARQUEES, ETC,) WILL REQUIRE
1: SEPARATE PERM;SSION.
Engr. Review
City Surcharge
PERMITAPPLICATI N: INDAYS
PERMIT Legull I YEAR -PROVIDEDWOR ISSTARTEOVWTHIN 1811DAYS
Engr. Inspection
state surcharge 4J,50
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPUCANT, ON BEHALF OF HIS OR HER SPOUSE, HEIFIS. 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 A13ENTI FROM ANY AND
Fire Review
Receipt #
ALLCLAIMSF0 DAMAGES OF WHATEVER NATURE, ARIS NO DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE F THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OB
Fire Inspection
Total Amount Due
REDUCE ANY REOUIREMENT OF My CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROl
Landscapainsp.
Receipt #
I HERE ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION A�_PF VAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGIE TO COMPLY WITH CITY AN. STATE a B15CIULATIN. CONSTRUIC'
CALL
This application 1, not a ponattledil signed by las,
Tie"; AND IN DING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THU�DSIOF THE STAT. OF WASHINGTON RELATING TO
FOR INSPECTION
B'" 7VI.1�11.1.11,eflnl .-. 1: and -..are paid, and
In is aclo,mladcz. space p—Red.
WORKMEN S COMPENS / S BE AND RCW 18.27.
F I S !IGNATURE DATN"
I SIGN41PE (OWNER d AGE
(425)
771-0220
EASED Y BAT
ATTENT19W
M 1333
/11h,
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
771-0221
( I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
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PINK -OWNER GOLD, ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ................
FOUNDATION:
Footing.................
wall.1 ........................
Pier/Porch .................
Z
Retaining Wail
.04
Slab Insulation ..........
PLUMBING:
Underground
M 01
r,
Rough -In ...................
IT! 0
-40
Commercial Final
HEATING:
X M
M z
ID -4
Gas Test ............
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Gas Piping .................
Equipment ..........
Oil
Commercial Final
-4 11,
M
EXTERIOR SHEATHING
NAILING
0Fn
FRAMING ..............
C: w
FIRST FLOOR FRAMING
ITI 0
INSULATION � ..................
X
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR U
OCCUPANCY