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CITY OF EDMONDS U"I'ER
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C0147STRUCTION PERMIT APPLICATION JAO`DAES1
OWNER NAMEINAME OF 0 LJYMNIF$S
PLAT NAMEISUBDIVISION NO. LOT L 1CNO.
I'D
I.P.
2-10 1 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY EXISTING - PROPOSED
"l'U'RIDDEIICATIOH- F1
NAME METER SIZE
LINE SIZE
NO. OF FIXTURES
I REQUIRED
I
I
ES 0 No C3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTRO
7_216 2 /0 tl -�5 7- 5 11) FIRE 11111.0 BY DATE
ZIP
STATE LICENSE NUMBER EXPIRATION oATE(rECXT VARIANCE OR CU P.CT. ....
:.E OSTED
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71_ j NO IF
LOT COVERAGE I REOUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL 0 PLUMBING I MECH ALLOWED PROPOSED I FRONT SIDE REAR FRONT US SIDE BEAR
ADDITION \&&MMERCIAL 0 COMPLIANCE OR
CHANGE 01 USE
0 RKING LOT AREA P NING REVIEWED By DATE
D I Mov
lg6 M ... L "0 APARTMENT IGN REIY PA DIED
&REPAIR [3 GRADING CYOS 0 FENCE
0 DEMOLISH 13 Fn AErfttjd
TANK
o GARAGE RETAINING WALL f;I
CARPORT 1:1 0 RENEWAL EL P64 /-7
OWE OF USE. BUSINESS ELI
CHECKED CC.PA.T
OF CRITICAL BY IV -co SOUP
WELLING SPECIALIN�PBCION IA..A ICY
M NUMBER NUMBER
STORIES UNITS NUMBER REQUIRED 0 YES
7=
OF SCRIBE WORK TO BE DO 0 E
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REMARKS
I ! PRQGFIESS INSPECTIONS PER USq_108/FINAL INSPECTION REO'D
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VA
VALUATION $
LUATION $
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Description
a �6
Plan Check
Plan Chock
HEAT SOURCE OWING I
L.OT SLOPE
VESTED DATE
FDn
Building
Su "ff-g
Plumbing
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WO K NOTED. THIS PERMIT COVERS WORK TO
Mechanical
tz BE DONE ON PRIVATE PROPERIn' ONLY. ANY CONSTRUCTION ON THE PUBLI C
Grading
Dr I g
(CURBS, SI
DOMAIN DEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
I
PER ITAPPISCATION: IN DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STA 0 WITHIN I.. DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLIO . ON BE -IF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Tre"'.
Traffic Mitigation
IN INTEREST, AGREIS To INDEMNIFY, DEPEND AND HOLD IIAIMLIIS THE CITY 01
—
EDMONDS. WASHINGTON, ITS OFFICALS. EMPLOYEES, AND AGENTS MOM ANY AND
Fire Review
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT $HAIL NOT BE
DEEMED TO MODIFY, WAIVE OR SEDUCE ANY
Fire inspection
REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
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Landscapeinsp.1
I HERE ACKNOWLEDGE THAT I RAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVE IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHOR ZED AGENT OF
I E OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS FIE13UWING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INISPECT11
WORKMEN'S COMPENSATION INSURANCE AND HOW 18,27�
ATE I.N..
SIGNATUR N77
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(42 91
5,
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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
10101
FAX
FEE
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt III
Total Amount Due
IZI
Receipt #
CATION APPROVAL
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in blinniI, copul, it Finn, .1. roild. no
VASED OATE
ORIGINAL -FILE - YELLOW -INSPECTOR
PINK�OVVNER - GOLD -ASSESSOR
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1711
RECORD OF INS PECTIONS
INSPECTOR
DATE APPROVED
'SETBACKS'.� ...........
%POUNDATION:
Footing ..i ..............
wall �J
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0
-I
Retaining �all
F)
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -in ...................
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0
0
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CommercIl Final
HEATING:
rn
IT!
Gas Test 11 ...................
Gas Pipin .................
Equl�msnt ..........
Commerc�al Final
m M
EXTERIOR SHEATHING
a
0
NAILING ..................
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c:
c ca
FRAMING
IT 0
FIRST FLOOR FRAMING
INSULATIOW .............
Floor Insulation
z
Wall Insuiation ...........
-4
3:
Ceiling Inpulation
z
0
SHEETROCH NAILING
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SPECIAL INSPECTION
0
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MISCELLANEOUS
FINAL APPR16VAL FO R
OCCUPANCY .............. vrl�