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1 PERMIT EXPIRES
CITY OF EDMONDS
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CONSTRUCTION PERMIT
APPLICATION
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OWNER ME/NAME IF BUSIN
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PLAT NAME/SUBDIVI SION NO. LOT NO.
LID NO.
MAILING ADDRESS
LID FEE $
IFESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Recid
CIV
TELEPHONE
EXISTING — PROPOSED
Inspection Required
Sidewalk Required 13
41
(Zt,p&l
L/V _16101CILP)
REQUIRED DEDICATION— FT
Underground
Wiring required 13
NAME
METER SIZE LINE SIZE OF FIXTURES PRV REQUIRED 43
YES13 NO 13 9
ADDRESS
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CITY ZIP
TELEPHONE
NAME
ICBLP
DATE
ENGINEERING REVIEWED BY
ADDRESS
CJA
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FIRE REVIEWED BY
DATE LU
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VARIANCE OR CU HORELINE OR ADB#
INSPECTION BOND
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EXMR TION DATE E Y
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NEW
RESIDENTIAL
0 PLUMBING / MECH
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FRONT SIDE REAR FRONT LJRSIDE REAR
1:1 ADDITION
E] COMMERCIAL
COMPLIANCE OR
13 CHANGE OF USE
ALLOWED PROPOSED
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El CYDS
ED FENCE
( X FT)
REMARKS
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(TYPE OF USE. BUSINESS OR A PLAIN:
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CHECKED BY OF CONSTRUCTION OCCUPANT
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NUMBER
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NUMBER OF
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
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VAI I I1%TIn"1
Description FEE Description FEE
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Plan Check zli"; State Surcharge 7-,-
HEAT SOURCE GLAZING % LOT SLOPE % City Surcharge
I Building Permit
PLAN CHECK NOy;Itj 12, e) a VESTED DATE PWmWng
I
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Qrriffing
11,,,/ 16
1
2
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF 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
a EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
V66
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp-
Total Amt. Due
L/
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Receipt #
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Recording Fee
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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 DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOIJ�1�017 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in spaca�provided.
WORKMEN'S CIRAPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE ATE
SIG U NE RAGE
D SIGNED
(425)
to
771-0220
BY DATE
PASED
ATTENTIPN
EXT 1333
IT IS UNLAVfUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
1 _,4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE YEL1OW-,*.,Pr:,',
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
04102 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 .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ....................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ... vnl
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR .7
OCCUPANCY ..................
N -
DATE . RECEI ED
7 PERMIT EXPIRES
�2 1 4 go
/�ERIVIIT
USE
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CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
UIT
IfR
'rEINAME BUSINr
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
JAVA I
ADDRESS
100 Zqofl- �-T- Az�y_
TELEPHONE
NAME
ADDRESS
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
UBL'C R' T 0
RW Permit Requ
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'ad
Street H.. Perm Roq'd
XIST
EXISTING PROPOSED
Inspection Required
rREQUIRED
Sidewalk Required
OU I DEDICATION— FT
underground
Wiringrequired
13
M R SIZ
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP
TELEPHONE
NAME
CBL I
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ENGINEERING REVIEWED BY
DATE
ADDRESS
C�4rjA
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DATE
CITY zip
TELOHONE
FIRE REVIEWED BY
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STATE LICENSE NUMBER
ATION DATE I
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REQ�6ft POSTED
..... 10YES 1$
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PALLOWED
SEPA REVIEW
SIGN AREA HEIGHT
I;IIPF[OPEFiTYTAX—ACCOUWFAR-CELNO.,
.
COMPLETE , EXEMPT
PROPOSED I ALLOWED I PROPOSED]
NEW
RESIDENTIAL PLUMBING / MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED FRONT SIDE REAR FRONT L/R SIDE REAR
ADDITION
COMPLIANCE OR
COMMERCIAL CHANGE OF USE
PROPOSED
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MULTIFAMILY SIGN
PARKING LOT AREA
REQ'D I PROVIDED
P7NING REVIEWED BY DIE
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REPAIR
GRADING FENCE
CYDS E] ( X_ FT)
REMARKS
0 DEMOLISH
TANK [:] OTHER
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GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR A(,-TffM VXPLAIN:
CHECKED BY OF CONSTRUCTION CODE OCCUPANT
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GROUP
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NUMBER
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CRITICAL
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SPECIAL INSPECTION AREA
—
OCCUPANT
LOAD
STORIES
NUMBER
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DESCRIBE WORK TO
BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION nr-u-ito
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VALUATIO V
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Pt.
Kill
Description
FEE
Description
FEE
Plan Check
4 17
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State Surcharge
HEAT SOURCE
GLAZIN G %
LOT SLOPE %
VESTED DATE
Building Permit
Ptumbing �Vq
11LAI
City Surcharge
6
PLAN CHECK NO.?el)
I . Mechanical
THIS PERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
B E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Cuading—
OMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE J7 o
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT UMrP I YEAR - PROVIDED WORK IS STAffMD WrTHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF 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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
I . Recording Fee :T�! ceipt # 9 7d
1 HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE 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- This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREITI, NO PERSON WILL BE EMPLOYED CALL Building Otficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged In space.providod.
WORK,MEN'S C�MPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE ATE
1 11
SIGNATUV'.(!5�NE IA95)
7_)DIR AGEI`K/ DIAXE SIGN�D 2 %-,We— 0
771 -C DATE
1220
�L' L ASED BY
%TTENTION' Exr 1333 /1'41
IT IS UNLAWOUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL f/ 1 Z4 /Z� - 1 (2 &_1 ' / f W,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW-INSPECk
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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