20020753.pdfI(
J--k DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
ADDRESS
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FLAT NAMEISUBDIVISION NO. LOT NO.
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PUSUC RIGHT OF WAY PER OFFICIAL $1 BEET MAP
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METER SIZE
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REMARKS
-OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTR
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FIRE REVIEWED BY
DATE
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STATE LICENSE NUMBER
EXPIRATION DATE
CHECKS By
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SEPA REVIEW
SIGN AREA
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PROPTRTYTAX ACCOUNTPARCELNO.
COMP
ALLOWED PROPOSED
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or
609D 1106
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EXP
[3 RESIDENTIAL
0
PLUMBING MEC H
LOT COVERAGE
REQUIRED SETBACK$ (FT.)
PROPOSED SETBACKS (FT.)
N:W
ALLOWED PROPOSED
FRONT SIDE REAR
FROM URSIDE REAR
A DR`I.N
COMMERCIAL
C MPLIANCE OR
CHANGE OF USE
I
0 REMODEL
0 APARTMENT
0
o SON
PARKING I
RE� ED
LOT AREA
1�51,11NG REVIEW ED BY
24i-
o FENCE
0 REPAIR GRADING CYGE
0 ( _ X FT)
REMARKS
[j DEMOLISH 0 TANK
0 OTHER
GARAGE o RETAINING WALL
CARPORT ROOKERY
RENEWAL
I
OWE ACTIVITY) EXPLAIN:
CHECKED BY
ITYPE OF CONSTRUCTION
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R MARKS
PRO BESS INSPECTIONS PER UBC IOS/FINAL INSPECTION REGO
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Description
FEE
Description
FEE
Plan Check
ounce SLOPE
LOT SLOPE %
IV, 6;
Building
F
DATE
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Plumbing
Mechanical V/
5�0
THISPERUM UTHORMS ONILY71BE WORK NOTEILTHIS PERMIT COVERS WORK TO
b: BE DONE ON PRWATE PROPERTY ONLY. ANY CONSTRUCTION ONTHE PUBLIC
�4'�
Grading
nulmo
Recording Fee
D OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEFARATEPESMISSION�
PERMITAPPLICATION: ISO DAYS
Engr. Review
City Surcharge
PERMIT LIMM. I YEAR � PROVID D WORK IS STARTED WITHIN IN DAYS
Engr. Inspection
State Surcharge
SSE BACK OF PINK PERMIT FOR NONE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Tratfic Mitigation
Plan Chk Deposit
IN INTEREST, AGREES TO INOEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Review
I Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM 'HE ISSUANCE (11 THIS PERMIT ISSUANCE OF THIS PER IT SHALL NOT E
DEEMEDTOMODIFY OR REDUCE REQUIREMENT M C ITYOROINAN
Fire Inspection
TotalAmountDue
WAIVE ANY OF ANY DOE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE MY ORDINANCE PROVISION.
Landscapelnsp.
Race
HEAEBY ACKNOWL ... E THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR TH DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I ABBE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC'
CALL
This application Is not a isearaft until signed by the
TION, AND IN DOING THE WO K AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or halhor Do ray: and Foos are paid, and
r ... Ipt lortrint-1.09pel Mrrpace p-lded.
WORKMEN'S COMPENSATI=RANCE AND HOW 18.2
SIGNATURE SIGNED
(425)
s1d. -0110 2—
771-0220
0
DATE
ATTENTION'
EXT 1333
02—
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
V - INSPECTOB
PINK - OWNER GOLD�ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ............
FOUNDATION:
Footing ......................
wall ...............
Pier/Porch ............
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
0
Underground.............
Rouih-in ...........
-j
M
Commercial Final
C
M
HEATING:
Gas Test .................
-4
x
IT!
Gas Piping ................
to -4
Equipment I .................
Cormneclair Final
0
EXTERIOR SHEATHING
-n
NAILING .......................
M
FRAMING
0
0
FIRST FLOOR FRAMING
0
C
INSULATION ...................
M 0
Floor Insulation
Z
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
z
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................