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RECEIVED
CITY OF EDMONDS
i,qq, PERMIT EXPIRES
USE PERMIT 7
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0 e NUMBER 7-
CONSTRUCTION PERMIT APPLICATION JOB SUITE/AP
ADDRESS 1 7 ]"-.r n
OWNER NAMEINAME OF BUSINESS
I L, L_ L�— PLAT NAM E/SU 13DIVI SION NO. 7
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MAILING ADDRESS
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NAME
ADDRESS
CITY
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ADDRESS
ZIP I TELEPHONE
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STA:�EJCENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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[3
NEW
E] RESIDENTIAL
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ADDITION
COMMERCIAL
REMODEL
APARTMENT
REPAIR
GRADING CYDS
Ej
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE. EIPPINESS OR ACTIVITY) EXPLAIN:
I
DAT E
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� FT
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE S
TESCP Approved
0
RW Permit Required
0
Street Use Pettrid pact d
0
Inspection Required
0
Sidewalk Requifed
0
Underground
Witing required
0
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED/DATE
7 /U
13Y
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PLUMBlhtS- EC
COMPLIANCE OR
CHANGE OF USE
SIGN
X FT)
OTHER
RENEWAL
NUMBER —1 NUMBEROF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % LOT SLOPE %
PLAN CHECK NO: 03—'q VESTED DATE
THIS PERMIT AUTHORIZES 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.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE 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 COMPENSAI=RANCE AND RCW 18.27.
SIGNATURN7ER ORtkGENT.)) DATE SI NE?
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND
REO'D POSTED
YES [:) NO
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SERA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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EXP I
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LOT COVERAGE
REQUIRED SETBACKS ("ED
SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE RE
UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REO'D I PROVIDED
CHECKEDBY ITYPE
OCCUR
GROUP
SPECIAL INSPECTOR JAREA ULIUU
OAD
REQUIRED E] YES L
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPI
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ATTE TION
ITISUNVA FU TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
C
A FINAL I CTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
5!98
VALUATION
PLAN CHECK FEE
BUILDING
Pttj�
MECHANICAL
41A;FE SURCHARGEZ'
ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
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RECEIPTe
TOTAL AMOUNT DUE
APPLICATION APPROVAL
A� C L This application is not a permit until signed by the
LL Building 011icial of his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
FOR INSPECTItON
OFFICIALS SIGNATURE DATE
(425) '_�l C
f�) '� �'o-)isj __'� / �4z 6
771-0220 LRELEASEJDA CATE
EXT 333
771-0221
ORIGINAL - ILE YELLOW - INSPECTOR
FAX PINK - OWNeS - GOLD - ASSESSOR
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RECORD OF INSPECTIONS 1 1
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .... I ............
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
OCCUPANCY ..................
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