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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER N&MEINAME �F BUSINESS
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PERMIT
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ADDRESS 7),,,) —7
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SUITE PT#
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NAMEISUBDIVISION NO.
LOT NO,
LID 110
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LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
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EXISTING — PROPOSED—
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I-para." ren.ad 13
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REQUIRED DEDICATION—
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METER SIZE
LIKE SIZE
NO, OF MIXTURES
PTV REQUIRED Is
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YES E3 NO 13 1 F
REMARKS
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WNER/CGNTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE 15
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ENCrNErIbtVGEO ak.,jectrical Permit fr*h
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FIRE
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VARIANCEOURCU S0091UNIOIAIIBI INIIICTION SON
POSTED
REQD
OYES [DINO $
SEPA REVIEW SIGN AREA HEIGHT
'0
, MPLETE , EXEMPT ALLOWED , PIIO1O11O ALLOWED , PROPOSE
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LOT COVERAGE REQUIRED SErBACKS (FT) PROPOSED SETBACKS JFT)
1,?K!)LUMBING/MECH
ALLOWED PROPOSED FRONT SIDE HEAR FRONT URSIDE BEAR
tKIJBIESH)ENTIAL
ADDITION E3 COMMERCIAL
COMPLIANCE OR
ro CHANGE OF USE
REMODEL n muLnpAMiLy
r N
SIC
PARKING LOT
REo PROVIDED
0 REPAIR 0 GRADING
0 PENCE
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REMARKS
0 DEMOLISH [3 TANK
Ei OTHER
o GARAGE o RETAININGWALL
[:] Fin SPRINKLER
FIRE ALARM
CA PORT ROOKERY
(ME OF USE, SUUSJ;j!���7-1,4
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GCCUPAN�e
IC ROUP
NUMBER NUMBER OF
OF DWELL HIS
CRITICAL
AREAS
SPECIAL INSPECTION OCCUPANT
STORIES UNITS'
NUMBS R
JAREA
REQUIRED [3 YES LOAD
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-REMARKS Z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 4
Description
D
FEE
Description
FEE
VPlan Check
State Surcharge
_
HEAT SOURCE GLAZING % LOT SLOPE %
B
B."de.. Permit
City Surcharge
PLAN CHECK NO:
kBribi..
Plumbing
THIS PERMIT AUTHORIZES ONLYTHE W RKNOTED, THIS PERMIT COVERS WORK TO
Mechanical
t 1110111"PIIEPRIIIII"IIIINII 111"I"THIP1111
Grading
DOMAIN ICURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATEPERUISSION.
PE MITAPPLICATION: INDAYS
Engr. Review
PERMIT LIMIT. I YEAR - PROIN ED WORK IS STARTED WITHIN '80 DAYS
Emir. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BE ALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALI. CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECR.Y
Fire Inspection
Receipt It
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF TH PERMIT S ALL NOT HE
I Y C
C Y
DEEMED TO MODIFY. WAVVE OR REDUCE ANY REQUIREMENIISOF AN ITHORDINAN E
Landscapeinsp.
Total Arm Due
NOR LIMIT IN ANYWAYTHE ITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
Receipt a
I HERE Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
_122L
APPLICATION APPROVAL
GIVE" IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I ACRE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC*
CALL
I nation Is not a fronaR Unlit signed by On,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYE D
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
..gThi-Pill
ding Official or hisihor Dop,ay; and Foos are paid, and
FOR INSPECTION ,c,lpti,,,k ... lodged 11 $Pace P-1,11d,
WORKMEN'S DIDIAPENSATION I SURANCE AND RCW 18,27.
DATE
BE INNER ATE SIGNED
(425)
_T
R"ELEASEDITY 46ATE
-ATTENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OR G NAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
Z$K'.OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE
MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETSACKS ...............
FOUNDATION:
Footing ............. b
Wall ...................
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Pier/Porch ...............
Retaining Wall ...........
ITI
Slab Insulation ..........
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PLUMBING:
ITI
Underground .............
rn 0
0
sough -in � ........... . .....
0
C
Commercial Final
ITI
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HEATING:
C —
Gastest
....................
CA
Gas Piping .................
0 _n
Equipment.................
ITI
Com morcial Final
0
EXTERIOR SHEATHING
0
NAILING ... .......................
MO
FRAMING ........... ............
z
71
FIRST FLOOR FRAMING
W
INSULATION ...............
z
Floor Insulation
Wall Insulation ...........
ca
Ceiling Insulation
SHEETROCK NAILING
171
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
AMR