20020313.pdfV
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PERMIT EXPIRES
CITY OF EDMON DS
U'E PE MITX
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CONSTRUCTION PERMIT APPLICATION
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SIUITIIAPTI
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OWNER NAMEINAME OF SU 'a,
1) i� MIS
PLAT NAMFJSUBDIVISION NO.
LOT NO,
1ID N
MMLINO ADDRESS
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING BED —
PROPO
CITY 'IF
ITELEPHONE
Or .1 il'11D_-� I"Ild
REQUIRED DEDICATION— 1
13
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED C
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ES
Y 0 NO 13
ADDRESS
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CI'T'Y'
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ENGINEERING D/DATE
ADDRESS
FIRE REVIEWED BY DATE
CITY ZIP
STATE LICENSE NUMBER EXPIRATION DATE
C KED Y
VARIANCE OR CU
SHORELINE OR MAP
INSRPEEQC�ION
0
E31EI [3NO
I BOND
1 POSTED
PROPERTY TAX ACCOUNT PARCEL NO.
�/ 9
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED , PROPOSED
0 NEW ESIDENTIAL 0 PLUMBING I MECH
'Aar
0 ADDITION 0 COMMERCIAL 0 COMPLIANO OR
CHANGE OF USE
0 REMODEL 0 APARTMENT 0 SIGN
�Zr.EPAIR 0 GRADING CYGE 0 F,NCE
( _ X FT)
0 DEMOLISH 0 TANK
oGARAGE 0 RETAINING WALL
CARPORT ROOKERY Oi RENEWAL
LOT COVERAGE
ALLOWED PROPOSED
REQUIRE SETBACKS IFT.)
FRONTD SIDE AFAR
PROPOSED A TOACKS (FT.)
FRONT LIRESKIE REAR
0
PARKING
REOD I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REMARKS
(TYPE OF USE, BUSINESS OR ACTI1Z
IRE
_ZM.E.
CH CKED By
GO
IVOCCUPA
GROUP
n
OF
0 STORIES
NUMBER OF
DWELL NO
U NITS
CRITICAL
AREAS
NUMBER
1-1111 IN.IE.T.A
A'ED JAREA
REOU A 0 YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 10811FINAL INSPECTION REGO
VALUATION $
Description
FEE
Description
FEE
Plan Check
HEAT SOURCE OWING
LOT STOP,
Building
PLAN CHECK NO:
VESTED DATiE
Plumbing
THIS PERMIT AUTHORRES ONLY THE ORKNOTED. THIS PERMrr COVERS WORKTO
Mechanical
Grading
t: IRE GONE ON P111 11110"1 ANY C0"1U1O" ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS EFS' ETC.) WILL REQUIRE
u
Engr. Review
SEPARATEPERM;SatONQ .
PIERMITAPPLICATION 180DAYS
D
PERMIT UMAB I YEAR -PROVIDED WORK IS STA OWiTHIN INDAYS
A
SEERACKCFPINKPERMU FOR MO EINFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
96ME"Oltigail—
Fire Review
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, ANDAGINTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCi OF THIS PERMIT SHALL NOT a
2DIFY.
Fire Inspection
WAIVE OR REDUCE ANY REQUIREMENT OF DINANS E
Of DEEMED TO My CITY OR 0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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I HERE ACKNOWLEDGE THAT I HAVE REM THIS APPLICATION; THAT THE INFORMATION
GIVE" IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNS . I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CALL
IN VIOLATION OF THE BE OF THE STAT OF WASHINGTON RELATING TO
FOR INSIPECTK
WORKMENS INS NCE AND Flow 18,27.
COMAENA�
SIONA:='E: DATE 6
(425)
=R
a 771-0220
7T'TENTION
M 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
10101
Recording Fee
City Surcharge
State Surcharge
Plan Chk Deposit
Receipt #
Total Amount Due
Receipt #
ORIGINAL � FILE - YELLOW . INSPECTOR
PINK - OWNER - GOLD - ASSESSOR
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0
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0
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ITI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....................
Wall ....................
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
in
C=
Rough -in ...................
M
0
0
C
Commercial Final
Z
HEATING:
171
Gas Test ....................
Gas Piping .................
Equipment ; ................
In io
Commercial Final
ITI m
EXTERIOR SHEATHING
0
NAILING ..........................
wis
0 Fn
FRAMING ............
ITI 0
FIRST FLOOR FRAMING
INSULATION ...................
Floor insulation
Wall Insulation
Ceiling Insulation
Co
SHEETR6CK NAILING
Z,
SPECIAL INSPECTION
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............
CODA. (93 1.3