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DATE RECEIVED
PERMIT EXPIRES
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U 'E PERMIT
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CITY OF EDMONDS NUMBER
JOB "UITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT Nb LID NO.
MAILING ADDRESS LID FEE $
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z TESCIP Appiroved
3r PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
0 4 street Use Pennit Flaq-d E3
CITY IP TELEPHONE EXISTING — PROPOSED inspection Required C3
S.Jtj�alk Required E3
REQUIRED DEDICATION— FT Underground
WA <51�Vo Wiringtoquirod
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NAKfE METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED C3
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15 1 1 1 - M
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OWNERICON'rRACFOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 3
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NAME cBL#
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CC ADDRESS
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STATE LICENSE NUMBER EXPI ATIQ[ DA E_ CHECK90 BY REDD POSTED
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SEPA REVIEW SI*GN AREA- HEIGHT
PROPERTY TAX AQC U T PARCEL No COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP 14
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E JCH' LOT COVERAGE REQUIRED SET13ACKS (Fr.) PROPOSED SETBACKS (F-T.)
NEW RESIDENTIAL PLUMBING( �M ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE (121 _t_�(gj V_x7o Q vAC�%,c z
PARKING [�LOT AREA PLANNING RiOIEWED BY DATE
REMODEL MULTIFAMILY SIGN REOD PROVIDED
FENCE
GRADING
REPAIR CYDS El X. FT) 41E N
DEMOLISH TANK )z I
Omed f-dy,eL
GARAGE o RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF U�SE, BU INI SS OR ACTIVITY) EXPLAIN: a-) i 4_L�� 1117-4 r S i
CHECKED BY jTff_Fp_0F C(PINISTRUCTION CODE OCCUPANI
GROUP
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1LU NUMBER NUMBER OF CRITICAL JAFfEA OCCUPANT
CRITIC
OF DWELLING AREAS SPECIAL INSPECTION
UNITS UM S LOAD
0 STORIES NUMBER REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS z
PRCLGREr
aS INSPECTIONS PER UBC I 08/FINAL INSPECTAON REQ'D F3
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Description FEE Description FEE
HEAT SOURE� GLAZING % LOT SLOPE % Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO, VESTED DATE Plumbing 21
Mechanical 1,50
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS. SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
to
PERMIT LIMIT 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 ro INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NA1 URE, ARISING DIRECTLY OR INDIREC rLY
x FROM THE ISSUANCE OF THIS PERMIE ISSUANCE OF THIS PERMIT SHALL NOT BE
a Landscapelnsp. Total Amt. Due
j DEEMED rO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
MI I Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAI' I HAVE READ THIS APPLICATION; THAT 1HE 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. This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building 011icial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGFON RELATING TO FOR INSPECTION receipt is aclinowledged in space proyided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
OFFICIAI§ SIGNX7URF DATE
SIGNATURE (OWNER AGENT�� - DATE SIGNED (425)
771-0220 RF[ FA�SED ;iY
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 04IGI��L/-Fll�__ YELLOW -�NSPLTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINKL9�VNER GOLD -ASSESSOR
04,102 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 ....................
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
..................
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