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PERMIT EXPIRES
CITY OF EDMONDS
us' PERMIT
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CONSTRUCTION PERMIT APPLICATION
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NAME
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STATE LICENSE NUMBER
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SHORELINE OR ADS# INSPECT[
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PROPERTY T��GCOIJNT IARCIL 11,
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COMPLETE EXEMPT
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
[:3 NEW 1:1 RESIDENTIAL 0 PLUMBING J MECH
LO COVERAGE
ALLOWED PROPOSED
REQUIRED SET KS (FT. PROPOS 0 SETBAC (FT)
FRONT SIDBACREAR I FRONT E US SIDE KRSEAR
>CCOMNI.RCIAL o COMPLIANCE OR
0 ADDITION CHANGE OF USE
I
PARKING I LOT
ARE I PLANNING REVIEWED By DATE
0 REMODEL 0 APARTMENT 0 SIGN
REa D I PROVIDED
FENCE
0 REPAIR 1:1 GRADING CYGS 0 X Fr)
REMARKS
�4-19YIOLISH 0 TANK
clGARAGE c3 RETAIN ING WALL 14
0 RENEWAL
CARPORT ROOKERY
(TYPE OF USE, BUSINESS ORI ITY) EXP�L/All��
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NUMBER 'UMBER 0 F 11C L
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NUMBS
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DESCRIBE TO BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REGID
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VALUATION $
Description
FEE Description FEE
Plan Check
HEAT SOURCE GLA2ING % LOT SLOPE %
Building
55-1
PLAN CHECK NO: VESTED DATE
PAWRISHIg
Ulti (A/L,
Mechanical
THIS PEAMPT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY 01 ANY CONSTRUCTION ON THE PUBLIC
Grading
Recording Fee
2 E
DOMAIN (CURBS, SIDEWALKS, DRIVEWAY% MARQUEES, ETC.) WILL RE.U..
SEPARATE PERMISSION.
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Engr. Review
En ` R
City Surcharge 5—
PERMITAPPLICATHRI: '"DAYS
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YEAR - PROVIDED WORK IS STARTED WITHIN IN DAYS
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Engr. Inspection
Eng 'a
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State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
I'D IT
Traffic Mitigat
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- Ian apost
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Review
Receipt #
I EDMONDS' WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Fire a"..-
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FROM THE ISSUANCE 01 THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 11
WA VE OR REDUCE ANY REQUIREME A ORDINAN E
9 E.M151) TO MODIFY I NT OF NY CITY
In IT
Spe-`o
Fire Inspection
FINSPECTION
Total Amount D
Ins
WAY I ANY ORDINANCE PROVISION. -
NOR LIMIT IN ANY HE CITYS ABILITY TO ENFORCE
Landscapalrep.
Receipt # 1122W
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
PIPUCATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
L
CALL
nep'! cati.. Ic net. parreft-fiI.Igned by Ih.
III,
PS.
TION; AND IN SON WILL BE EMPLOYED
ED -7.1"14' WASHINGTON RE.IN. TO
IN VIOLATION OF THE LA nD�N F"T.E STATE
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, 01pnis,c k-100 Bed In space P
FOR �i;vidcd. I
WORKMFITS COMPENS INSURAN E AND RCW 18,27,
,SURA E
IRGNANER 6R�GENT) DATE ONE
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FICIA SIGNATt
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77' 22
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ELEAIED BY
ATTENTION 7TI
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI
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
10101
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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0
Pier/Porch .................
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
M
C
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, I�N
Underground
0
0 C=
Rough -in ...................
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Commercial Final
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HEATING:
Gas Test ...............
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Gas Piping W..,
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Equipment ..........
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Commercial Final
0
0
EXTERIOR SHEATHING
NAILING ...........
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FRAMING ........................
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74
FIRST FLOOR FRAMING
INSULATION ...................
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Floor Insulation
Wall Insulation
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Ceiling Insulation
0
SHEETROCK NAILING
ITI
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
o
OCCUPANCY ..............