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DATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS 9
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CITY ZIP TE EPHONE
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NAME
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ADDRESS
ZIP TELEPHONE
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,296 Allo;`I�SZ-61,0
CITY ZIP T il_�PHONE
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STAtE LICENSE NUM13ER XPIJR
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IN
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'KRD BY
NEW
ESIDENTIAL
PLUMBING / MECH
ADDITION
rCOMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
El
MULTIFAMILY
SIGN
REPAIR
11
GRADING
CYOS
FENCE
[ x FT)
DEMOLISH
13
TANK
OTHER
o
RETAINING WALL
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FIRE SPRINKLER
EGARAGE
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CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS FV ACTIVI10 EXPLAIN:
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Lu NUMBER NUMBER OF CRITICAL
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OF DWE NG AREAS
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DESCRIBE WORK TO BE N�E
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PERMIT EXPIRES
USE PERMIT
ZONE NUIV
JOB
SUITE/APT#
ADDRESS ZP 3 �� b P,
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
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Street Use Permit Roq'd
E3
EXISTING - PROPOSED
Inspection Required
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Sidewalk Required
REQUIRED DEDICATION- FT
Undorgrr>und
Wiring required
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METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DAT E
FIRE REVIEWED By DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
I A-JIC LIAJtF 1.(VM11QT1
LOT COVERAGE
ALLOWED PROPOSED
PARKING OB
REO'D I PROW
REMARKS
SHORELINE ORADBI I INSPECTION I BOND
REO'D POSTED
[1YES ONO 1$
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SIGN AREA HEIGHT
ALLOWE D . PROPOSED I ALLOWED . PROPOSED
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REQUIRED SETBACKS (F�E) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAM SjObg� L/R SIDE REAR
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DYN ON I*V 0.
IIT'.R SHALL NOT
CHECKED BY ITYPE OF CONSTRUjTION CODE OCCUPANT
GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED C] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing C? jqjI4SC-- D
Mechanical CqI
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due 1
R _T_ IReceipt 9
ecording Fee
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION, receipt is acknowledged in space provided
0 1 S SIGNAT AT
(425)
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771-0220 _FflEASED BY I DAT1?'
'ATTENTIOV t:A 1 1 J%5%3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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
04,102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VEST E D 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 100 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION�l
I HEREBY ACKNOWLEDGE THAT I 14AVE 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.
RE (OWNER OR DATE -d-NVED
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
Underground ............. 0 M
Rough -In ................... M 0
0 C
Commercial Final ...... K
M
HEATING: M z
C _ZGas Test .................... >
Gas Piping .................
0
Equipment ................. n
Commercial Final .......
M M
EXTERIOR SHEATHING 0
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0 r-
NAILING .......................... 0 M
C CD
FRAMING ........................ 9 Cn
Q 0
FIRST FLOOR FRAMING ... Z
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INSULATION ................... ;U
Floor Insulation ......... >
z
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Wall Insulation ...........
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ... M
C,4
MISCELLANEOUS ..........
FINAL APPROVAL FOR d
OCCUPANCY ..................
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