20020393.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
.."M MENAME OF BUSINESS
MA LING ADDRESS
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PERMIT EXPIRES
us PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
FLAT NAME/SUBDIVISION NO. I LOT NO. L
L�D NO.
OFEES
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
a. I.— ..a."
a'.
42.1 Ps. I Send
EXISTING — PROPOSE — 'z. sen n.
REQUIRED DEDICATION— FT — --s
METER SIZE I LINE SIZE I NO. OF FIXTURES P REQUIRED
YES E3 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY
F12E REVIEWED BY DATE
VARIANCE OR CU
SHORELINE OR ADS#
INSPECTION
BOND
STATE LICENSE NUMBER
EXPIRATION
ES
0YREIIkNO
�OSTEI
IROPER��
'�75 P77
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9,9 ev
C SEPA REVIEW
OMPLETE EX
EXP —I Z
SIGN AREA
ALLOWED PROP SED
=1�7
HEIGHT
ALLOWED PROPOSED
—i—
NEW
0 RESIDENTIAL
LUMBING
LOT COVERAGE
REQUIRED SETBACKS (FT) PROPOSED
SETBACKS (FT.)
I MECH
ALLOWED PROPOSED
FRONT SIDE AM
FRONT QRSIDE BEAR
ADDITION
COMMERCIAL
COMPLIA CE OR
CHIANGE OF USE
0 REMODEL
0 APARTMENT
SIGN
HiA
I PLANNING REVIEWED BY
FENCE
[3 REPAIR
[3 GRADING DYSS
( _X_FT)
REMARKS
—
[3 DEMOLISH
0 TANK
[3 OTHER
'70
o GARAGE
CAR ORT
R.=.NyG WALL
[3 RENEWAL
(ME OF USE. BUSINESS
OR N:
CHECKED BY COD OCCUPAN T
NUMBER —
NUM ER (IF 1
CRITICAL
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7TRU
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I GROUP -
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OF _5
STORIES
SWELL NG
I U NITS
AREAS
NUMBER
SPECIAL IN'-fiCTOR
RED Cl JAREA
USE YES
[PROGRESS
OCCUPANT
LOAD
IZA LArucir-r
RENA KS
AA I
INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D
as
VALUATION
. .. ...... GLNG %
LOT SLOPE %
Building
PLAN CHECK NO:
_�a�3
I VESTED DATE
Plumbing
THIS PERMIT AUTHOFUZES ONLY THE WORK NOTED. THIS
PERMIT COVERS WORK TO
Mechanical
IC BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
o DoMAIN (CURBS, SIDEWALKS, DRTREWAYS MARIBI ES" ETC j WILL REQUIRE
Grading
Recording Fee
:3
t SEPARATE PERMissIoN.
PERMIT APPLICATION: INDAYS
Engr. Review
City Surcharge
PERMIT LAMIR I YEAR - PROVIDED WORK IS STARTED WITHIN 'so DAYS
Engr. Inspection
State Surcharge
SEE MCK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS,ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
IN INTERIST, AGIIIII TO INDEMNIFY, DEFEND AND HO D HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
—
Fire Review
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER MATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED To moDIFY
Fire Inspection
Total Amount Due
WAIVE OR HE UCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITN'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscapoinsp.
Receipt #
777, 71
I HEREBY ACKNOWLEDG THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPRdVAe
"'C'
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Thi-ppication 1. a.. P.-Rindfl.19n.d by dre
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA E
THE STAT OF WASHINGTON RELATING TO
FOR INSPECTION
Building Officiat,r his/her Betray; and Fees are paid. and
1pt 1—kneetedged 1, space pecedded,
WORKMEN'S C A/ NWNOF
T;��
omPENs CE AND ACW 18.27.
jo"ER o B EAm
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(425)
OF LS ATUR DATE
MRS
I
771 -0220
q2N(16
RrFD BY T_DATf_
ff'ON
EXT 1333
IT IrlWF.l TO - lsF nm FIZP�A A, it, FRIUr 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
... � ',i YELLOW !INSPEdOR
total
FAX
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .............
FOUNDATION:
4*1 (3
Footing ..............
0z
wall ..............
Pier/Porch
Retaining Wall
Slab Insulation
PLUMBING:
Underground .............
Hough -in ...................
Commercial Final
HEATING:
Gas Test ..........
Gas Piping .................
Equipment ..........
Commercial Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ............ ...........
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETR OCK NAILING
SPECIAL INSPECTION
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