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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
RA NAMERIAME OF BUSINESS
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.ING ADDRESS
ZIP TELEPHONE
CITY ZIP ITELERIONE
PERMIT
ZOFLI
4
/ NUMBER,
ADDRESS 21 o'Z'Z 7`4A01A PT*
FIAT NAMEtSUBDIVISION NO I LOT NO LID NO,
' FEE It
I. 'BE
1USLIC FIGHT OF WAY PER OFFICIAL STREET MAP
It .
EXSTING� PROPOSED —
REQUIRED DEGICATION� F1
IRV REQUIRED
YES 13 NO Cl
REMARKS
ENGINEERING FE—VIEWrO
By UL 1JUIiiij- I LLI DATE
ADDRESS
FIRE REVIEWED By
DATE
On . Y TELEPHONE
11�e
At rue� 981 282-
-- SON
'OND
_
ATE ECKED BY
VARIANCE OR CU
M
GFECT"M
SKORELINIORAD81 INIFECTIO
D POSTED
To POSTED
STATE LICENSE NUMBER
RED
OIES ON.
I ES ON" I
011PI8111IN
2-
- "HT
SIGN AREA EIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW
OMPLETE EXEMPT
E
A B .. POSED
'L.W=
ALLOWED PROPOSED ALLOWS PROPOSED
q60 zo/
P
i
LOT COVERAGE
't PROPOSED SETBACKS
REQUIRES SETBACKS (Fr.) PROPOSED SETBACKS tFT.)
NEW RESIDENTIAL MECH
EW
FRONT a SIDE BEAR
ALLOWED PROPOSED FRONT SIDE BEAR FRONT UPSIDE HEAR
C N�
OMPLIA OR
ADDITION COMMERCIAL 11 CHANGE OF USE
I
REMODEL MULTIFAMILY [3 SIGN
1:3 F..OGEL
PARKING
REUD PROVIDED
L AREA I PLANNING FIEVIEW11 BY 'AT'
Fj GRADING FENCE
REPAIR CyDS [3 1 _ X _Fn
REMAIjKlObtain
Electrical
DEMOLISH TANK [3 OTHER
S
Labur-&1aduakk&-
GARAGE RETAINING WALL ;71.SPlllHKL.
11 FIRE ALARM
State
CARPORT DOCKERY
(tYPE OF USE, RUPSISS OR ACTIVITY) EXP N:
CHECKED By TYPE 0 A �OUPAN`rk
ISTRUCW OG
I , e f
X7 )v— -
Up
III
;4
C
-WU—MOER NUMBER OF RMC L
OF WELLING A GAS
ECIALINSP5CIRON AREA
L CCUPANT
OAD
..IT MR
STOP UMBER
IES
REQUIRED [I YES
DESCRIBE WORK TO BE GONE
REMARKS SPECTION REO'D
PROGRESS INSPECTIONS PER UBC 1081FINAL IN
/is STO v d 's Pj /i C,;t
L&L4JV1&14 F-00al
57
VALUATION
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GIAZING Lon SLOPE ts
Building Permit
City Surcharge 6
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHOfirrES ONLY THE WORK NOTED. 'HIS PEIRMnC.1�FISWO"KT0
UOTIONON F
t: 11 DONE *" P111 P111ERGV 1111 ANY I'"STR TH-PUBLIC,
Grading
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPLICATI N: INDAYS
A. PERMITLIMT 1 YEAR - PROVIDED WORK is STARTED WITHIN 18. DAYS
Engr. Inspection
SEE DACKOF PINK PERMIT FOR MORGINFORMATION
'APPLICAM. ON BEHAL OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire ReView
Plan Chit. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 1HE CITY OF
EDMONDS' WASHINGTON ' ITS OFFICIALS, EMPLOYIFES, AND AGENTS F OM ANY AND
Fire Inspection
Receipt If
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE Of THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Arm Due 75
DEEMED To MODIFy, WAIVE OR REDUCE ANY REQUIREMENT OF MY CITY ORDINA CE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
ggg)—
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT,THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DOLY AUTr ORIZED AGENT OF
THE OWNER. I AGREE TO C MPLY WITH CITY AND STME LAWS REGULATING CONSTRUC�
0
CALL
This applicafillh-t 8 omit until signed bY line
TION; AND IN DOING THE WORK AUTHORSIED THEREBY NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
8.1khro Official a, hiseher Dennis: -0 Fees -'A Pudd, a'
NSPECTION elpfl—k—kn1gedin.p.a. p
FOR 11 me ed
IN VIOLATION OF THE LABOR CODE OF THE STATE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
OFr
&OR
(425)
714,
_�
771-0220 RELEASED .9
ATTENTION/
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-
OSGINAL.FIL - YELLOW -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PZ-OWNER - GOLD -ASSESSOR
04102 PRESS HARD -YOU ARE MAKING
5 COPIES GREEN � ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
�j
..........
Pier/polch .................
Retaining Wall ...........
Slab Insulation .......... .
PLUMBING:
M
C
R1
Underground .............
0
0
Rough -in ...........
C
:C ITI
PR
Commercial Final
HEATING:
CE
8,
Gas Test ............
0
Gas Piping ........... as
-4
3:
Equipment .................
1711 M
Commercial Final
0
EXTERIOR SHEATHING
C
NAILING .................
M 0
FRAMING .................
z
FIRST FLOOR FRAMING
INSULATION ...............
z
Floor Insulation
ca
Wall Insulation ...........
z
Ceiling Insulation
SHEETROCK NAILING
M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..............