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DATE RECEIVED
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PERMIT EXPIRES z
CITY OF EDMONDS
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USE PERMIT
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NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITEIAPT#
ADDRESS
OWNE NAMENME OF BUSINESS
PLAT NAME]SUBDIVISION NO, LID NO.
MAILWG ADDRESS
LID FEE S
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TESCP Appf=-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Per it R
Street umse Peffnit F1,80
CITY ZIP E
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EXISTING — PROPOSED inspection Required
Sidewalk Required
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REQUIRED DEDICATION— FT underground
Widno required 13
NAME
METER SIZE LINE SIZ OF FIXTURES PRV REQUIRED
I YES13 NO CI
ADDRESS
N/A
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
0 NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FROW LIRSIpf REAR
ADDITION 0 COMMERCIAL COMPLIANCE OR
1:3 CHANGE OF USE
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REMARKS
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BU
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NUMBER NUMBER OF ]'CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION OCCUPANT
STORIES UNITS NUMBER
JAREA
REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
531 SPECTIONS PER UBC 108/FINAL INSPECTION RE 'D,
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Description FEE Description FEE
Plan Check State Surcharge 5 -0
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
VESTED DATE
Plumbing
pyl L
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
3 DOMAIN (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
-
Engr. Review
PERMITAPPLICATION: ISO DAYS
I
PERMIT LIMM I 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
NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL
Landscapeinsp.
Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Receipt N
Recording Fee
I HERE13Y ACKNOWLEDGE THAT I 1`19AD-" APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECT� AND THAT I THE OWIWA. OR THE DULY AUTHORIZED AGENT OF
��E
THE OWNER. I AGREE TO Compt ITH QWf'AND STATE LAWS REGULATING CONSTRUC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING AU ZED THEREBY, NO PERSON WILL BE EMPLOYED
G U
IN D�I �N�A
IN VIOLATION HE R OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or hisftr Deputy: and Fees are paid, and
receipt Is acknowliodgad In space provided.
WORK OMP SURANCE AND FIC �.7.
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OFFICIALS TURE TE
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1
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771-02AMP
10
RELEASED BY
ATTENTW
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-
ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
RECORD*OF
INSPECTIONS
ANSPECTOR
DATE APPROVED
SETBACKS .............
V
FOUNDATION:
Footing......................
.......................
Oler/Porch: ..........
Retaining Wall ...........
Slab Insulation .
..........
PLUMBING:
M
Underground .............
............
Rough -In ........
0
dorrimercial Final ......
m
HEATIM
'Gas Tbst ....................
-Gas, Piping .................
40
Equipmen t ......... �".
c Final
ommercial ........
:EXTERIOR SHEATHING
NAILING .............. ........
W.
FRAMING
..................
q "Ar
FIRST FLOOR FRAMING...
INSULATION
...................
Floor Insulation .........
I T
Wall insulation .... ......
1 YDATE RECEIVED
6��
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
O)NNEP E OF BUSINESS
MAUNG ADDRESS
CITY
NAME
ADDRESS
CITY
4
ZIP PELEPHONE
18020 V001401115
AWIP
LICENSE NUMBER
xa& '1 0 )_+
)/03
PERMIT EXPIRES
vSE PERMIT
ZONE
NUMBER
JOB
SUIMAPT#
ADDRESS 71407.,, 40T-f+ <
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIR ApprO"d
RW Pefrnit Required
Street Use Psmvn Raq'd
EXISTING — PROPOSED
inspection Required
Sidevalit Required
REQUIRED DEDICATION— FT
Underground
WirIng(equired 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
YES13 NO C3
REMARKS
OWNERICON ESPONSIBLE FOR EROSION CONTROL/DRAINAGE
�� 21 2.7-0
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TELEPHONE -1 f I F fcz
CBL 0
TA ENGINEERING REVIEWED BY DATE
DATE
EkEPHON
FIRE REVIE&D"Eff I
IN
4 2- `70—S viv A
710�
XPIRATION DATE VARIANCE OR C SHORELINE OR ADB# INSPECTION BOND
0 POSTED
5-0 41 NO1$
COM SEPA REVIFW SIGN AREA HEIGHT
PLETE . EXEMPT I ALLOWED . PROPOSED I ALLOWED . PROPOSED
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
REPAIR
_?>41LILTIFAMILY
GRADING CYOS
DEMOLISH
TANK
0 GARAGE
CARPORT
RMNINGWALL
ROCKERY
PJR ACTIV
(TYPE OF USE, BUSMI um �Mj
NUMBER
NUMBER OF
OF e3
I DWELLING
14
STORIES
UNITS
DESCRIBE WORK TO BE DONE
Ell
W
or
m
PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS jFr.)
ALLOWED PROPOSED FRONT SIDE REAR FROU LL
COMPLIANCE OR k2jj"REAR
CHANGE OF USE re
PARKING PSLAG REVIE�WED BY DAT
SIGN REO`D I PROVIDED
FENCE
X—FT) REMARKS
OTHI
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
- R 61biqg —
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORUMS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMITAPPUCATION: 180DAYS
PERMIT UMM. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORIMATION
'APPLICANT, ON BEHALF OF 141S OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCEiORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD� HARMLESS.THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICLAIS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ TH110 APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT'. AND THAT I E OW>1.?� OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO . .
6�� STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING-THE-W IZ -6 THEREBY, NO PERSON WILL BE EMPLOYED
IliE
R SUaOF,
IN VIOLATIONCW-tHE R E OF THE STATE qEWASHINGTON RELATING TO
CE 0
WORKMEbfirCOMP= SURANCE AND RCW W.27.
SIGNED
CHECKED BY I r CON IILL"qN C2 .I OCC T
,F GROUP
SPECIALINSPE ION A EA OCCUPANT
REQUIRED 0 YES LOAD
REMARKS
P50GRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION RECtD
X& LC W11,0i I'm /IN A,0 e— I-pl"rk V"j 18
$ L17
, 3
FAM a-7-A
Description
FEE
Description
Descr'
FEE
Plan Check
State Su ircharge
14/150
Building Permit
City Surcharge
r
k15. --
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review.
Plan Chk. Deposit
FI reInspection
Receipt #
Landscapeinsp.
Total Amt. Due
030
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
.111s�
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building OMcW or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
OFFICIALS IGN177URE 9ATE
7, 04 �_
1 1
RELEASED BY DXTE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER(, GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING