20020703.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NMEINAME OF BUSI
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STATE LICENSE NUMBER 'T �N v
[aiPERMIT
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FLAT NAMEISURDIViSION NO.
LOT NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED—
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REQUIRED DEDICATION— FT
METER SIZE
LINI'SIZI
NO, OF FIXTURES
PAV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
FIRE REVIEWED BY DATE
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SHORELI�E OR ADHe T
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RC NO,
COMNUETE - EXEMPT
ALLOWED PROPOSED
LOWED PRO10111
EXP
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NEW RESIDENTIAL PLUMBING I MSCH
LOT C VERAGE
ALLOWED PROPOSED
REQUIRED S BACKS PRO, BED SETBACKS (FT.)
FRONT Sir C REAR FRONT ILIRSIDE REAR C
COMPLIA CC OR
COMMERCIAL CHANGEOFUSE
gADDITION
REMODEL MULTIFAMILY 0 SIGN
0
PARKING
REO' PRO IDED
LOT A REVIEWED BY DATE
0 REPAIR 0 GRADING CyOD FENCE
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REM RKS
E] DEMOLISH TANK or C.
GARAGE RITAININGWALL o FIRESPRINKLEA
CARPORT GOCKFRY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
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CHECKED BY IT,
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JMBER CRITICAL
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SPECIAL INSPECTION JAREA occu NT
LOAD
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REQUI RED
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DESCRIBE WORK TO BE DONE I KJS7j A-LLIJQ6E7 12-01S l7-JVE49MZ'
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PER USC 108/FINAL INSPECTION REGID
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PROGRESS INSPECTIONS
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FEE
Descriptl
FEE
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Plan Check
State Surc a a
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
Ci Surcharge
PLAN CHECK NO: IISTEI OATS
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Me "Umical
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THIS PERMrr AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK 70
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS
SEPARATE PERM; MARQUEES, ETC.) WILL REQUIRE
SSION,
Engr. Revievv
PERMITAPPLICATI he 180DAYS
PERMIT UMM. I YEAR -PROVIDED WORK IS STARTED WITHIN ISODAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
ON EICHALF 01 HIS OR HER SPOUSE� HEIRS, ASSIGNS AND SUCCESORS
Fire Awl"
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND HOLD HARMLESS THE v .1
EDMONDS . WASHINGTON ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR OAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
111011 THE SIUANCI 01 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL 101 BE
Landscapeinsp.
Total Amt. Due 1777
ANY C
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ITY ORDINAN E
NOR LIMIT IN ANY WAY THE CiTYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW'
Recelpt #
I HEREBY ACKNOWLE BE THAT I HAVE READ THIS APPLICATION; THAI THE INFORMATION
-ATION 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
n.,arde-litannel-ani.led,
Fees are and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EM PLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
8 o"ie'ra 0, t�grn 'apni, and paid.
go I'v —ta— ad.
FOR INSPECTION ...'p, dead
WORKMENS CONFERS SURANCE AND HOW 18.27,
S SKI ATURE DATE
IR
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ABED BY
ATTtNTION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIG NAL - FILE. - YELLOW - INSPECTOR
it
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
PJNX. OWNER GOLD, ASSESSOR
.-
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 .................
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Retaining Wall ...........
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Stab Insulation ..........
PLUMBING:
A -n
Underground .............
0 M
Rough -in .... .............. I.
MO
0
Commercial Final
0
HEATING;
M M
Gas Test ....................
Gas Piping .............
Equipment .- ..............
0 _n
n
Commercial Final
M M
EXTERIOR SHEATHING
NAILING .........................
017 n
0
FRAMING ............ I ...........
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FIRST FLOOR FRAMING
Q 0,
INSULATION _ .................
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5 Floor Insulation
Wall insulation ..........
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Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION
0
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MISCELLANEOUS
FINAL APPROVAL FOR
OCCUPANCY ..................