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PERMIT EXPIRES 1�f
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
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S awalk Required 13
U'ndderground E3
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CITY TELEPHONE
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NAME
METER SIZE
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NO. OF FIXTURES
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NUMBER
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NPHUUMM001 SPECTIONS PERJIBC 108/FINAL INSPECTION REG'1011
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VALUAMON
$ 1 ALOW
1,41 5— 1/0 11.0
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building P .1 ermit City Surcharge
PLAN CHECK N0�0,� VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
116 PERMIT LIMIT! I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
C�X C/
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAJMS 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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Fire Inspection
Receipt #
/7 44
7x L L.0
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
APPtICZTION APPROVAL
This application Is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
I 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
OFFICIALS SIGNATURE DATE
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WORKMENT COMPENSATION INSURANCE AND RCW 18.27.
(425)
AdON URE (OWNER OR
DATE SIGNED
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771-0220
EXT 1333
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RELEASE BY ATE
rLEY
ATTENTION
IT IS UNLAWFULTO USE OR OCCUPT A DUILLANU On a Inu
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR NAL LE Y LLOW-fNSPECTC
- Y LLC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 Pini'FNIER - TGOLD-ASSESSOR
04/02 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:
GasTest ....................
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 64
OCCUPANCY ..................
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DATE RECEIVED
mom
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
3
CITY TELEPHONE
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NAME
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CITY ZIP I TELEPHONE
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ZIP — I TELEPHONE
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LICENSE NUMBER �xp"FIAJIUNIJAIL I qHECKEDl
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TAX ACCOUNT PARC91. NO.
PERMIT EXPIRES
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NUMBER
JOB SUITEIAPT#
ADDRESS(T
rPLAT NAME'SU'D'V'S'9N NO. LID NO.
�:b 1.1 rj I �OT NO.
LID FEE $
TESCP ApproVed
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Partnil Required
Street Use Permit Roq 'd
EXISTING — PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT Underground
Wiringrequifed
METER SIZE LINE SIZE _[ 0. OF FIXTURES PRV REQUIRED
YEs13 NO C3 9
REMARKS z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NEW
RESIDENTIAL
13 PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
1:1 CHANGE OF USE
REMODEL
0 MULTIFAMILY
1:1 SIGN
E] REPAIR
GRADING
FENCE
CYDS
( Fr)
X
DEMOLISH
TANK
OTHER btr �S
GARAGE
RETAINING WALL
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o FIRE SPRINKLER
F RE ALARM
CARPORT
ROCKERY
(kYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN'
1. 11 ei
NUMBER
fNUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES Co
UNITS
U
NUMBER
DESCRIBE WORK TO
BE DONE
WA�
HEAT SOURCE I GLAZING % LOT SLOPE %
PLAN CHECK NO�) VESTED DATE
THIS PERM IT AUTHORIZES ONLY THE WORK NOTED. THIS PERM IT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURaS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE 1) IERW"ION.
PERMIT APPLICATION: ISO DAYS
PERMIT YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
*BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, 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 CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
I HEREBY 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
d1GkNjtURE (OWN R OR DATE SIGNED
E �KNT) " ' /
4 1 'f 1. . /V I t) �__-
DATE
FIRE REVIEWED BY DATE W
cc
I M
VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
REO'D
POSTED
1$
E3YES,,WO
—
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWE PROPOSED
_XP ,
LOT COVERAGE
REQUIRED SETBACKS
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE
FRONT URSIDE REAR
35X. "0 he,
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PARKING
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LOAD
REMARKS
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PROGRESS INSPECTIONS PER -UBC 108/FINAL INSPECTION REO'D
Lag --x"-4h & rou P r1a /I t4l J,
$
Descilption FEE Description FEE
Plan Check rm�) State Suircharge
F
Building Permit City Surcharge
Plumbing 619L'17
Mechanical
Grading
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
-/ 7- /,P
Recording Fee
Receipt III
,/F `7
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foos ari paid, and
FOR INSPECTION
receipt Is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
(425)
771"022,20
RELEASED 13Y DATE
ATTENTION E)Cr 1333 / /
I i I /"J�Vl /! 1";7ol,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 1; / if, 41 __j. 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
I GREEN ACCOUNTING
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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