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I BE PERM T
CITY OF EDMONDS ZONE UM
N B'ER C�ZV _9
CONSTRUCTION PERMIT APPLICATION JOB ess D 1UFTi
AUDIT
OWNER NAMEINAME OF BUSINESS f5oebtess PILAT NAMEISUBDIVISION NO, LOT NO. LI NO.
MAILING WDDRES U. FEE I
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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CITY zip 67Z A 1 (0 EXISTING— PROPOSED —
REQUIRED DEDICATION— FT
NAME ..... __+MET11 1111 1 ,HE SIZE NO, OF 1IXTURE1 11V REQUIRED
YES E3 No 13
FTE�
ADDRESS REMARKS
F.,
W-1r.-TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
1 -1 or, zip ITELIPHONi
as ADDRESS
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FIRE REVIEWED BY DATE
or, ZIP
TELEPHONE
VARIANCE OR CU
SHORELNEORAD81
BOND
POSTED
STATE LICENSE NUMBER EXP
E ED
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
EIGHT
ALLOWED ,
_�OPOIED
PROPERTY TAX ACCOUNT PARD.
(19 7&I'l &0
NEW IS RES DENTIAL 0 PLUMBING I MECH
ADDITION COMMERCIAL COMPLIANCE 08
1:1 0 CRANGEOFUSE
rj REMODEL [] MULTIFAMILY E3 SIGN
LOT COVERAGE
ALIO;Z/ZIOIED
SQUIRED SETBACKS III
FRONT SID, REAR
111
PROPO ED SETBACKS (Fr.)
FRO UR SI E REAR
t,4 A,
PARKING
RE
ED
LOT AREA
NO REVIEWED By DATE
n GRADING CYOS M FENCE
REPAIR 4 — ._ Fn
rl DEMOLISH M TANK ri OTHER
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GARAGE
C R [3 FIETAININGWALL F RE SPRINKLER
A PORT ROOKERY Fine ALARM
W"OL �PG�I-r (-6t-JE_ ':;zilr - V= I L-15,
ITWWSE, BUSINESS OR A PATY) EXPLAft,
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OCCOANT
GROUP OL- 1��
NUMBER
OF
- STORIES
0
NUMBER OF
DWELU G
UNITS
ECIALINSPE AREA
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RE 1
OCCU NIT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER USC 11i NAL INSPECTION PEaD
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ION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECKM_ ;S:: I VESTED DATE
03
Plumbing
Mechanical
THIS PERMITAUTHORUESONLYTHE WORK NOTED. THIS PERMIT COVERS WORKTO
17 REIDONEONPRWATEP OPERTY ONLY, ANY CONSTRUCTION ON THE PUBLIC
ad
Grading
mg
2 ,
,t OMAIN (CURDS, SIDEWALKS, DRIVEWAYS MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERM;SSION.
REVGW
Engr. Review
E n g,
PE MITAPPLICATION: UIODAYS
PERMIT LIMM I YEAR . PROVID D WORK IS STARTED WITHIN 180 DAYS
E
g
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
' "action
, H, on HER SPOILS , HEIRS, ASSIGNS AND SUCCESORS,
'APPLICANT ON OEHALF 11 1 E
Fire Review
FIT.
Plan Chk. Deposit 1z
IN INTEREST, AGREES TO INDEMNIFY, SPEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire '-Sp-ol'on
Receipt #
A L CLAIMS FOR DAMAGE WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
'IS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT E
FEn
FR M THE ISSUANCE OF
Y ITY C
TO WAIVE R REDUCE MY REOUIREMENTOFAN C ORDINANIBE
Landscape Insp.
L G
Total Amt. Due lb5x
DEEMED MODIFY,
01 NOR LIMIT IN ANY WAY THE CUTS ABILITY TO ENFORCE ANY ORDINANCE PRWISION,'
Recording Fee
Receipt # k4d,52,a
I HEREBY ACKNOWILE BE THAT I HAVE READ THIS APPUCATION� THAT THE INFORMATION
APPLICATION APPROVAL
GIVE is CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
N CONSTRUC-
This api haa a ps,.h.hfil slgh.d by M.
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING
NO PERSON WILL BE EMPLOYED
C
CALL
9, ildi.g Offl.I.I., hillh., OaPhY: hd Fasa a,. paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
...IpHs.xkn-1,sd,.dip .. ph.AdchL
WORKMEN'S COMPENSATION tt SUMNCE AND ACW 18,27.
IIINATUIE DATE
CATY714ED
42
f 51
(425)
_%,IAL1
5��=
771-0220
'A�TIION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
'61'01NAL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
FILE YELLON.iNSPECT6R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
p,K-OWNEP G LO-ASSIESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .................
FOUNDATION:
Footing..............
wall ..........................
Pier/Porch . ................
Retaining Wall ...........
'Slab Insulation
PLUMBING:
Underground
Rough -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
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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