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PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER zC1 C
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CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS SUITE/APTs
OWNER NAMEiNAKIE OF BUSINESS
IL PLAT NAME/SUBDIVISION NO LOT NO LID NO
MAILING ADDRESS LID FEE S
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET M 13
/ -7 C: AP TESCPApproved
0 Rvv Permit Wquitud C3
Soeet use Petmil Ri-quiied 11
CITY ZIP 1 ELEPI TONE EXISTING PROPOSED inspection Reqwwa El
side6alk Requlfej
L REQUIRED DEDICATION FT Uneitiground C3
e Vdirinci foquirea 13
NAME ME TER SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED
YES 13 NOO 9
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"- ADDRESS REMARKS W
!E OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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CITY ZIP TELEPHONE
NAME CBL$$
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ENGINEERING REVIEWED BY DATE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATIP.N PATE CHECKED BY VARIANCE OR Cu SHORELINE OR ADB4 INSPECTION SE A
L_ REO'D COMPLETED EXEMPT
'17 Akl 0 YES 13NOI
Ael OUNT PARCJ-1 NO CA# ZONE SIGN AREA HEIGHT
PROPELITY T�� �
WAIVER 13 ALLOWED , PROPOSED ALLOWED , PROPOSED
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2L)i /(/�o STUDY 13
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
COMMERCIAL X, ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
ADDITION �K( COMPLIANCE OR z
MIXED USE CHANGE OF USE z
El 1 2
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY E] SIGN REQ'D I PROVIDED
GRADING FENCE
REPAIR CYDS E] ( X FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE Ej RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESfi OR ACTIVITY) EXPLAIN:
CL NSTRUCTI CoDr? OCCUPANT
R TYPq,011 OPT GROUP 92
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uj NUMBER 14UM13ER OF —
OF DWELLING SPECIAL INSPE�fi6N CONSULTANT OCCUPANT
0 STORIES UNITS REQUIRED 13YES LOAD
DESCRIBE WOR—K TO BE DONE RE44ARKS
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CLA lije 51 KI GEOTECH REPORT
BY
STRUCTURAL DESIGN
BY.
VALUATION
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$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SO�RCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
T- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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(L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
In Fire Review Plan Chk. Deposit
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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Z 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 BE
Landscapelnsp. Total Anit. Due C/
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt ILI,
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 Thih application is [lot a PL-rillit (111til 51(ified by The
THE OWNER, I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his1her Deputy and Fu'
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED esafe Paid. and
IN VIOLATION OF THE LAI�LOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION ruceipt is ackriuMedged innpaci� provi(It-d
WORKMEN'S COMPENSy ANCE AND RCW 18:27.
1pff N�R
klEic IGNAT(U��" DATE
SIGNATURE (0 INTER AGENT): DATE SIGNED (425)
771-0220 RELEASIED BY ATE
ATTENTION EXT. 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I \ / ( I le I Lj
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FIL� �-El LOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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� SETBACKS .....................
FOUNDATION:
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Footing......................
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. / Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
^ ' Rough -In ...................
Commercial Final --
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HEATING: '
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� Gas Test .................... .
Gas Piping ----~
Equipment .-----
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Commercial Final --
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EXTERIOR SHEATHING �
' NAILING .......................... .
FRAMING........................
' FIRST FRAMING '.
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' INSULATION ...................
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Wall Insulation ...........
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FINAL APPROVAL FOR
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