20020295.pdfPERMIT EXPIRES
CITY OF EDMONDS
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PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
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OWNER NAMEINAME OF BUSINE
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ADDRESS
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PLAT NAMEISUBDIVISION NO.
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MAILING ADDRESS
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NAME
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LINE SIZE
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PRV REQUIRED
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ADDRESS
ZIP ITELEPHONE
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTAOILIDRAINAGE
NAME 'C
ENGINEERING
ADDRESS
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REVIEWED BY
REVIEWED/OATE
DATE
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CII-1E. .71
SHRELrVEQ_"D'# I INSPECTION j'B.ND
r1YREO.D ORTED
ED r1NO
COMPLETE EXEMPT
E.1 I
I ALLOWED , PROPOSED
ALLOWED I PROPOSED
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LOW OVERAGE
ALLOWED PROPOSED
REQUIRED SMACKS IFT) PROPOS
FRONT SIDE HEAR
SETBACK$ (FT.)
FRONT Lie SIDE REAR
ADDITION
COMMERCLAL
C E
CHANGE OF USER
2
AIEMODEL
APARTMENT
0 SIGN
PARKING
RECIND I MISS.
LOT AREA
PLANNIN REVIEWED BY DATE
REPAIR
GRADING GYDS
FENCE
( _ X FT)
REMARKS
DEMOLISH
[3 TANK
OTHER
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I ARPA.'ST.
o RETAINING WALL
ROOKERY
U RENEWAL
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DESCRIBE WORK TO BE DONE
REMARKS de
INSPECTIONS PER USC 1081FINAL INSPECTION REaD
__-1PROGRESS
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VALUATION
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1
11
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MIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS
PERMIT COVERS WORK TO
Mechanical
1: HE DONE ON PRIVATE; PROPERTY OHLX ANY CONSTRUCTION ON THE PUBLIC
0 ONDUN (CURES- SIDEWALKS, DRIVEWAYS, MARQUESS, ETC.) WILL REQUIRE
Grading
Recording Fee
SEP�TEPEAMISSION.
2
P2"Mar
Engr. Review
City Surcharge
APPLJ"O': 'so.
PERMIT Uum I YEAR -PROVIDED WORK IS STARTED WITHIN HODDAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
/V
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEMS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, IT$ OFF1014LS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OFTHIS
PERMF. ISSUANCE OF THIS PERMIT ALL NOT F
SH
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY ITYORDINANCE
Fire Inspection
Total Amount Due,
C, NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
Landscapainsp.
Receipt
2
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOK THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT Or
APPLICATION
APPROVAL
THE OWNE . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thl-pplicalkal is.. dreench.efil signed by in.
TIOR ANDIIIN DOING THE WORK AUTHORI ED THEREBY!, NO PERSON WILL BE EMPLOYED
Bullsang Official a, his/her Derarty: and Fees a, read, and
I VIOLATI
N ON OF THE LABOR CODE OF THE STAT OF WASHINGTON RELATING TO
WORKMENIS COMPENSATION INSURANCE AND RCW 16,27.
FOR INSPECTION
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SIG Us (OWNER
(425)
OFfiIhIAL1 IIGNATU DATE
R`R'
7710220
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DATE
ATTENTION
E;�: 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
1 1 OR101NAL � FILE - YELLOW INSPECTOR
10101
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .................
FOUNDATION:
Footing.....................
Wall ..........................
Pier/Porch .................
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Retaining Wall ..........
0
MIS
Stab Insulation
PLUMBING:
7 -oz
M
Underground .............
M 0
0
Rough -In
0
C
Commercial Final
M
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HEATING:
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to
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Gas Test
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Gas Pining ....
0
Equipment ................
Commercial Final
m M
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EXTERIOR SHEATHING
0
0
NAILING ..........................
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FRAMING . ........................
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FIRST FLOOR FRAMING
INSULATION ..........
Floor Insulation
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Wall Insulation
C0
Ceiling Insulation
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SHEETROCK NAILING
0
IT
SPECIAL INSPECTION