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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
JOB
SUITSIAPT#
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OWNER NAMENAME OF BUSINESS
or
PLAT NAME/SUBDIVISION N!717!77
I'D NO.
WILING ADDRESS
LID FEE S
CITY
PUBLIC RIGHT OF WAY PER OFFICAL STREET MAP
EXISTING
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— PROPOSED—
REQUIRED DEDICATION—
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S.—A., 11.1
AMC
METER SIZE
USES
PAV REQUIRED
YES 13 NO 0
AIIRE81 I
REMARKS
E I ONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME 6-64 �,�1,12
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ENGINEERING REVIEWEDIDATE
A DDRESS
FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER .ZED BY
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
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13 YES �KO
BOND
POSTED
Q PROPERTYTAX ACCO__
$EPA REVIEW
COMPLETE
EXP
SIGN AREA
"EIGHT
ALLOWED PROPOSED
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E] NEW a' I PLUMBING I
I COMPLIA CE OR
0 ADDITION 0 CHANGE OF USE
P RT.UNT
P"REMODEL 0 SIGd4
0 REPAIR rl GRADING CYDS 0 FENCE
X FT)
0 DEMOLISH TANK 0 OTHER
0 GAR ET
AGS REFAINING WALL
CARPO ROCKERY [3 RENEWAL
LOT COVERAGE
ISQP..�.
REQUIRED SETBACKS IFT)
ISO. SIDE FEAR
I
PROPOSED SUTUACKS (FF.)
FRONT Ll..'.0 BEAR
1 1,651 !�WAA16�—_
REqG`.A RKING
I
I PROVIDED
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LOT AREA
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REMARKS
C,=NESS OR ACTIVITY) EXPLAIN:
(THECKED BY
TYPE OF,7! ION
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STORIES
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DWELLIN '4
UNITS
ACRITICAL
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OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER URIC IOD/FINAL INSPECTION REG`D
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VALUATION $ 6?
a
Plan Check
___70__TSLOPE %
d".
Building
PLAN CHECK VESTID I
m
Plumbing
[GG"rading
MechEanical
THIS PERMIT AUTHORIZED ONLY THU WORK NOTED. THIS PERMIT COVERS WORK TO
t� BE DONE ON PRIVATE PROPERTY ONLY. ANY CoNSTRUCTION ON THE PUBLI C
2
Recording Fee
0 OMAJN (CURDS, SIDEWALKS, DRIVEWAYS MARQUEES. ETC,) WILL REQUIRE
SEPARATIEPERMiSSION.
—
Engr. Review
City Surcharge
PC MITAPPLICATION: INDAYS
PERMIT LIMM 1 YEAR - PROVID -D WORK 15 STARTED WITHIN red DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
State Surcharge
WILICANT, ON BEHALF 01 HIS 011111 SPOUSE, HEIRS, ASSIGNS AND IUCCEIORI
IN INTEREST, AGREES To INDIMNII, E11ND AND HOLD HARMLESS THE CITY OF
Traffic Mitigation
[Landscapainsp.
Plan Chk Deposit
EDMONDS ' WASHINGTON. ITS OFFICALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Review
Receipt # -7 q
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
1.1 TO MODIFY WAIVE OIL REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCI
Fire Inspection
Total Amount Due
IT IN ANY WAY THE CITY$ ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Receipt # 8P O�Z
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DUIY AUTHORIZED AGENT OF
_jg,
APPucA-rION �PPRCIVAL
THE OWNER. I AGREC TO COMPLY WITH C17Y AND STATE LAWS REGULATING CONSTRUC.
CALL
Thleripplin.11-1. nert.p.-Ift-W signed by Me
TION; AND IN GOING THEWORK AUTHORIZED THEREBY. NO PERS N WILL BE EMPLOYED
IN VIOLATION OF THE LABOR THE $TAT 0 WASHINGTON RELATING TO
DIP
FOR INSPECTION
Bellaire Wider., Welbe, "ejedy: and Fees are Pald, and
WOSKME�,S COMPENSATIZ^E AND .
�U No I.Z1. DIF7
(425)
OFFICIALS SIGNATURE DATE
]2IGNA 4
771 -0220
ATTENTIO
EXT 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-
ORIGINAL,FILE - YELLOW. ?NSPECTD/R
CATE OF OCCUPANCY HAS BEEN GRANTED. USC SECTION 109
FAX
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .......... ..........
FOUNDATION:
Footing...................
Yfall..........................
Pier/Porch ..............
Retaining Wall ...........
Slab Insulation ..........
M
PLUMBING:
Underground .............
V)
0 In
Rough -in ...........
C
IT
0
Commercial Final
0
HEATING:
ITI
M
JD
GasTest ..............
Gas Piping .................
Equipment ............
0 -n
Commercial Final
EXTERIOR SHEATHING
M M
NAILING ..........................
0
0Fn
FRAMING ...............
C: C4)
K ch
FIRST FLOOR FRAMING
Q 0
INSULATION
4
Floor Insulation
Wall Insulation ..........
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ceiling Insulation
CO)
SHEETROCK NAILING
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SPECIAL INSPECTION
0
171
MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................