20020478.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
CITY
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PERMIT EXPIRES
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ADDRESS
FLAT NAMEISUBDIVISION NO.
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NO.
L FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
13
EXISTING _ PAOPOSEO__
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REQUIRED DEDICATION FT
MMER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUI.R%
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REMARKS
OWNER]CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE
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n NEW FLU.EING4 EC. LOT COVERAGE REQUIRED SET ACKS (FT.) PROPOSED ETBACKS (FT.)
RESIDENTIAL
ALLOWED PROPOSED FRONT SID: BEAR FRONT USSIDE BEAR
COMPLIANCE OR
[3 ADDITION COMMERCIAL CHANGE OF USE
El
PARKING I LOT AREA PLANNING REVIEWED DATE
REMODEL MULTIFAMILY rl SIGN REQ'D I PROVIDED
n FENCE
REPAIR GRADING CYDS ( — FT) REMARKS
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RETAINNGWALL FIRE SPRINKLER
0 GARAGE Ry( L_J FIRE ALARM
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REMARKS
PROGRESS INSPECTIONS PER UBC IGO/FINAL INSPECTION REOFO
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Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE
Building Permit
City Surcharge S7
PLAN CHECK NO: VESTED DATE
Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOT THIS PERMIT COVERS WORK TO
Mechanical
t BE DONE ON PRIVATE PROPEFM ONLY. ANY CONSTRUCTION ON T EPUBLIC
HREG
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.F WILL UIRE
t: SEPARATE PERMISSION.
"Ef"'B"APPUCATION: IN DAYS
Engr. Review
PERMIT LIMIR I YEAR - PROVI ED WORK IS STARTED WITHIN 180 DAYS
Engr. inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHAL OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
PlanChk.Deposit
IN INTEREST, AGREES TO INDEMNIFY!, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, III 0111CIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OFF INDIRECTLY
Fire inspection
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE GUYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Landscapoinsp.
Total Amt. Due
Recording Fee
Receipt FT
1 HEREBY ACKNOWLE GE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION 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.
CALL
pfl.0.. J..W. p-4-01 Iign.d by
T ION; AND IN D01NO THE WORK AUTHORIZED Iff RESY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAUDS CODE OF THE STAT OF WASHINGTON RELATING TO
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FOR INSPECTION '_1pHkn-I,XJ,.dI..p ... pldn.
WORKMENS CO��SATII N INSURANCE AND RCW U127.
SIGNATJ.REffWNE_"R AGE" DATE SIGNED
OFFICIALS SIGNATURE ATE
612
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77(14-2052)20
8 DATE
ATTENTION
EXT 1333
IT IS UNLAWFUL To USE OR OCCUPY A BUILDING On STRUCTURE UNTIL
*.YI.LIN�l
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
141LE -/IE�LL.E
'KSP OZ,
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK OWNER � GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GnEEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing
wall
z
Pier/Porch .................
Retaining Wall ...........
0
Stab Insulation
PLUMBING:
Underground . ............
13 M
M
0
Rough -in ...................
0 C
Commercial Final
-4
X IT
M z
-4
HEATING:
C:
Gas Test
>
Gas Piping
Equipment .................
rommorol.1 Final
RIM
0
EXTERIOR SHEATHING
0 f-
0
NAILING ..........................
C
FRAMING ........................
Q 0
FIRSTFLOOR FRAMING
INSULATION ...................
Floor Insulation
z
Wall Insulation ...........
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Calling Insulation
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SHEETROCK NAILING
IT
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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