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USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION J013 ri SUITE/APT#
ADDRESS
OWNER NAME/NAME OF 13USINESS At)(�.
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G%A PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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7ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Puirnit Required [3
0 ��,Q A- 53"A A v e W Street U50 Permit Roq'd [3
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required C3
Sidewalk Required E3
REQUIRED DEDICAIION_ Fr underground
Wiring required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NIA YES 13 NO 13 z
REMARKS z
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OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 53
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I VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIR N DATE VNCHECKE9�.BY RE POSTED
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ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED ED
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NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
E] ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL -/7"
CHANGE OF USE 11:f 3 1 21-5
PARKING LOT AREA I PLANNING REVIEWED BY DATE
1:1 REMODEL El MULTIFAMILY SIGN REQ'D I PROVIDED IL
F1 REPAIR GRADING FENCE 1W Che 15,Z-7& jol
CYDS ( X FT) REMARKS V
F-1 DEMOLISH TANK OT6e
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GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONSTRUCTION ODE OCCUPANT
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PPECIAL INSPECTION JAREA OCCUPANT
UNITS NUMBER -OUIRED [— LOAD
DESCRIBE WORK TO BE DONE OW _] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit L City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I:= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
tu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 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 '40
U) Plan Chk. Deposit, 5
�j IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 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 SHAIL NOT E
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY Landscape Insp. Total Amt. Due
0 1, 1 1 "-7--
ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." Recording Fee Receipt #
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 APPLICATION APPROVAL
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 Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION reccipt is acknowledged in space provided.
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WORKMEN'S COM PEN SATIO914SU RANCE AND RCW 18.27.
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SIGN,j RE (OWNER,( N -[DATE IGNEI,,,
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L 771-0220 11LEA ED BY DAT
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ATTENTION EXT 133,
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL )adi,az t
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI- ORIGINAL - FILE YELLOW - INRPF__TnP
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
Rough -In ................... M
M 0
Commercial Final ...... 0
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HEATING:
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Gas Test .................... M z
Gas Piping ................. C z
Equipment ................. 3:
Commercial Final ....... o -n
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EXTERIOR SHEATHING
NAILING .......................... M 1711
FRAMING ........................ 0 r-
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation ....... --I
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SHEETROCK NAILING ... CD
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SPECIAL INSPECTION I
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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