20020872.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O"U"N"
MAILING ADDRESS
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.ITY
11P ITEIEPHONE
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ADDRESS
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CITY ZIP
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STATE LICENSE NUMBER EXPIRATION
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PROPERTY TAX A6COUNT PARCEL NO.
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RESIDE
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ADDITION COMMERCIAL CHANGE OF USE
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DESCRIBE WORK TO BE DONE
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USE PERMIT
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70 _63-D-
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ADDRESS 16-40-7_ 23
FLAT NAMESUBDIVISION NO. I LOT NO. L�D NO.
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LID FEE a
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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EXISTING — PROPOSED 13
REQUIRED DEDICATION— Pr
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YES 0 NO 13 sa
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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IN
FIRE REVIEWED BY
DATE
GO POSTED
10YE's Owls
SEPA REVIEW SIGN An- HEIGHT
COMPLETE , EXEMPT ALLOWED -BE- ALLOWED ROPO"O
XP I PRO, I P
LOT COVERAGE REQUIRED SETBACKS "T. ROP BED ETBACKS (Fr.)
ALLOWED PROPOSED FRONT AIDS BEAR FFAONT LJR SIDE REAR
PARKING LOT AREA I PLANNING RIBREWED BY DATE
REOQ I PROVIDED I
CHECKED BY I TYP: GRO
S .. P . ECIALINSPECTIONIA AiWA OCC
REQUIRED 0 YES
REMARKS
PROGR Be INSPECTIONS PER UBC 1081FINAL INSPECTION REaO
$
F
Description
FEE
Description
FEE
Plan Check
State Surcharge
T
LOT SLOPE !a
NCOVEASWORK
Building Permit
City Surcharge
PLAN CHECK NO:
—
VESTED DATE
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Plumbing
THIS PERMIT AUTHORIZES ONLY THE W RK NOTED. THIS PERMIT TO
Mechanical
t: HE DONE ON PRIVATE PROPEAny 00
NLY, ANY CONSTRUCTION ON THE PUBLIC
Grading
0 OMAIN (QUARS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
2
Engr. Revievv
PEAMITAPPLICATI He IN DAYS
PERMIT LIMIT. I YEAR -PROVIDED WORK IS STARTED WITHIN 180DAYS
Engr. Inspection
SUB
GET BACK OF PINK PERMIT FOR MORE INFORMATION
IPPLICA.T. ON E.11 01 .,a A HER .10U.T. EIRE, ASSIGNS AND SUCCISORS
Fire ReView
Plan Chill, Deposit
2 IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENf$ FROM ANY AND
I ALL C'MS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Fire Inspection
Receipt N
9 FROM THE ISSUANCE OF MIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WA 0 REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapeinsp,
Total And. D..
0
.1 NOR LIMIT IN ANY WAY TIVECITY'S ABIL17Y TO ENFORCE ANY ORDINANCE P [SION.-
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE AM THIS APPLICATION; THAT T14E INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC�
T;ON; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIDLATIO CODE
CALL
a Pablit �11 signed by the
Au" D
ag b d1her splay; and Foos old paid, and
OF THE STATE OF WASHINGTON RELATING TO
WORKMEN's INSURANCE AND ROW 18.27.
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FOR INSPECTION
lec'Jiltol" ke-ledged In are— P—Ided.
DATE SIGNED
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(425)
OM� L TE
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ENTION
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1111A111 BY UAT
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING R STRUCTURE UNTIL
I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
OHGINAL-FIL - YELLOW � INSPECTOR
04/02
P:NK-OWNEER - G UD-ASSESSOR
PRESS HARD -YOU ARE
MAKING 5 COPIES
GREEN . ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Fooling ......................
Wall ...........
Pier/Porch .................
Retaining Wall ...........
Stab 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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