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EXPIRES 14L
CITY OF EDMONDS
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PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO.
LOT NO� LID No.
UCATIONJA'
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LID FEE It
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PUBLIC RIGHT OF WAY PER OFFIC!AL STREET MAP 1W P.— A
EXISTING — PROPOSED—
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METER SIZE I LINE SIZE
I NO. OF FIXTURES.. PRV REQUIRED
YES 13 N
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FIRE 'E"B"'D By
FIRE NEIIEWED By
DATE
STATE XIINAHON DATE,%IIECKED BY
VARIANCE OR C U
SHORELINE OR ADBAkZ_ I INSPECTION '80 D
Ptak. CITED
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COMPLETE EXEMPT
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NEW
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PLUMSINGIMECH
LOT COVERAGE REQUIR BED SETBACKS (FT)
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P .P.
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ADDITION
COMMERCIAL
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CHANGE OF USE
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APARTMENT
:W—SIGN
PARKING
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LOT AR REVIEWED
0 REPAIR
GADING CYOG
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0 DEMOLISH
n TANK
El
iV AP'n-ovA
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o RETAINING WALL
13 RENEWAL
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ROOKERY
(TYPE OF USE. 0117141017
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jC.ECKED.Y ITYy1C-NSrRU ION OCCUPANT,
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NUMBER
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UMBER OF
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DWELL No
I CRITICAL —
I AREAS
OCCUPANT
LOAD
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NITS
I NUMBER /10
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1��INSPECTOR
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JAREA
DESCRIBE WORK TO BE DONE
PERUBC
'ON $
VALUATION $
VALUAT
Description
FEE
Description
FEE
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�DeserlptIOL
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HEAT SOURCE LOT SLOPE %
Building
PLAN CHECK NO: V E T D A T E
Plumbing
Mechanical
P or W K -to
INIS PERMrr AUTHORIZES ONLYTHE WORK NOTED. THIS PERMIT COVERS WORKTO
or N 0 T H E P C
BE DON, ON PRIVATE PROPEFrrY ON. A. CONSTRUCTION 0. THE P.EnJC
Grading
Recording Fee
C LL It B U E
0.. (CUR., SIDEWALKS, DRIVEWAYS, MARQUEES,ETCJ WILL REQUIRE
I
PERMISSION.
SEPARATE
GT
Engr. Review
.7
City Surcharge _7
3—
PERMITAPPLICATI N: 150DAYS
W ' N 'a - A 'a
PgRUITUM" I VEJU1. PROVIDED WORK IS STARTED WITHIN 180 DAYS
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Engr, Inspection
State Surcharge
T
SEE BACK OF PINK PERMIT MR MORE INFORMATION
BU
A a N EA D C ....
N
'APPLICANT, ON BEHALF OF HIS 08 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Traffic Mitigation
Plan Chk Deposit
H M L S B C TV
IN INTEREST. AGREES TO IND MNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
AM
Receipt #
Fe Y
EDMONDS. WASHINGTON, ITSEOFFICIALS. EMPLOYEES. AND AGENTS FROM ANWAND
Fire Review
T'y
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Fire Inspection
Total Amount Due
Moor AIVE OR REDUCE MY REQUIREMENT OF ANY CITY ORDINANCE
CEEMED,TO
NY
HE CIWS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,�
Y T ov
OR LIM T IN ANY �YVAW
Receipt #
Landscapelnsp.
NA HE N, .'I
I HEREBY ACKNOWLEDGE T HAT � HAV E READ THIS APPLICATION;177 T I - ON
APPLICATION APPROVAL
AM UL Y UT on ZE GENT
GIVEN IS CORRECT, AND THAT THE OW A, OR THE OULY AUTHORIZED AGENT OF
AND STATE LAW
To COMPLY , Ne RE.U' No D.NSTRUC.
THE OWNER. I AGREE ON CITY 'a REGULATING CONSTRUC-
CALL
s`1.'P'.Id,
P... Le
TION; AND IN DOING THE W K AUTHORIZED THER . P. ON WILL BE EMPLOYED
OF THE STATE F WASHINGTON RELATING TO
.�FTW�.Pp""'
CTIO!, d InecOffit 1.1 and
ce
FOR INSPECTION iplisackno,tedgedinspaceWovlded*
IN V1 ION OF THE LABOR CODE
WOR E �S co?'PENSA�I U NCE AND ROW 18.27.
OFF11CIAGNATU11 DATE
SIGN us I R 0 DATE SIGNED
1 251
4
(425)
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P
771-02�20 RELEASED BY DATE
AI
EXT 1333
j�
MEt'bN
IT 1.1 U FUL To USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
U
771 -0—
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
1 ORIGINAL �CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, USC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
wallI., .......................
Pier/Porch .................
z
RetainIng Wall
Slab k6sulklon ..........
0
PLUMBING:
Underground ..........
M
Rough -in ...............
M 0
Commercial Final
0
C
HEATING:
M
Gas Test ; 7*
10-4 t
z
Gas Piping .................
_X,
co
Equipment
0
Com mercial Final
M ITI
EXTERIOR SHEATHING
co
NAILING .............. . ..........
0
5 Fn
FRAMING ........................
C (j)
FIRST FLOOR FRAMING
M 0
Z
INSULATION ...................
X
Floorinsulation
-4,
Wall Insulation
z
Ceiling Insulation
SHEETROCK NAILING
z
SPECIAL INSPECTION
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. ........ ...