20040393.pdfPERMIT EXPIRES
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/JSE PERMIT
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CITY OF EDMONDS NUMBER
JOB -SUITE,AP1
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
1�1 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO,
LID FEE S
Ir MAILING ADDRESS
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AP
z PUBLIC RIGHT OF WAY PER OFFICIAL STREETMAP RVJ Pe,mit Reqtwed 0
?- ) ��. �,-, .�)_ I L Street Use Permit Req d 0
0 inspection Required 0
CITY ZIP TELEPHONE EXISTING — PROPOSED Sldewll� ReqUitcd 0
2 REQUIRED DEDICATION � FT Underground
Ming required 0
METER SIZE ZE NO. OF FIXTURES PRV REQUIRED
NAME
YES 0 NO 0
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ADDRESS REMARKS
OWNER/CONTRAC TOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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GAS PIPE TEST musT BE
CITY ZIP TELEPHONE OBSERVED BY CITY INSPECTOR.
NAME AFFIDAVITS SHALL NOT
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CC ADDRESS
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FIRE REVIEWED BY cc
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION
STATE LICENSE NUMBER EXPIRATION DATE CC EID Y REO'D IPOSTED
0 YES C] NO 1
A— SEPA REVIEW SIGN AREA HEIGHT
F COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW [Si/RESIDENTIAL EY/PLUMBING if MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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REMODEL APARTMENT SIGN REI'l B or vent connectors
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Ej REPAIR GRADING CYDS X FT) REMARKS _]_VUIq_Jvvk' i-burmugappuancesla
DEMOLISH TANK OTHER pnees.
GARAGE RETAINING WALL RENEWAL
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(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: CHECKEDBY JTYPEOF7C �UCT?N CODE OCCUPANT
CL GROUP 03
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th NUMBER 5_3 I OCCUPANT
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OF DWELLING AREAS SPECIAL INSPECTOR JAREA LOAD
UNITS NUMBER REQUIRED [::] YES
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DESCRIBE WQRK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D F3
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HEAT SOURCE,-/ GLAZING LOT SLbPE BUILDING
VESTED DATE PLUMBING
�LAN CHECK NO.
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC GRADIN&FILL
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. x,
"STM-E-SURCHAR
a: PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ENG REVIEW rEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION ENG. INSPEC NON PEE 0"
V) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
UJI IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS rHE CITY OF LANDSCAPING
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND INSPECTION FEE
m ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY RECEIPT
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDI NANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILI7 Y TO ENFORCE ANY ORDINANCE PROVISION RECEI
m I OIAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT I HE INFORMATION APPLIbATION APPROVAL
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGEN I OF
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULA"I ING CONS TRUC Tiusapplicallotl;, nal it f�ermil until signod by ll�le
CALL Boilaing Official or h,s,lnei Derarly and Pousare L)aid',jr(,,
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TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE FMPLOYED 13 nq
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IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 10 FOR INSPECTION recttql m spdcL �lfclvlcjld
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18.2 vpv SIG�A],URE DAT E
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771-02 HEL�AST_D 13Y
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ATTENTION EXT 333
ITIS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK OWNER GOILD-ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS� .......
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Footing ...........
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Comme�qiAl Final
HtATING'
Gas Test ...................... �5
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING .....................
FIRST FLOOR FRAMING...
INSULATION .........
Floohntuldti6h ......
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
0 CCUPANCY ..................
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