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PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBERA""L.,41'0�/ /!?� )
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CONSTRUCTION PERMIT APPLICATION ADDRESS z
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OWNER NAME/NAME OF Ess L
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UMA: MAILING ADDRESS LID FEE S
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0 -7 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP nw Ponflit Finquired 13
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CITY ZIP TE EPHONE EXISTING — PROPOSED od 13
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REQUIRED DEDICATION— F1 Undii.iground
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NAME METER SIZE LINE �IZE NO. OF FIXTURES PRV REQUIRED
YES NO
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CITY ZIP TELEPHONE
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NAME CBL;s
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CITY ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR ADBP ]INSPECTION BOND
STATE LIL-ENSE NUMBER EXPIRATION DATE Cq�KED BY REO'D POSTED
umm— 5 / YES ONO S
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
60 Lu EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
NEW RESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LiR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL z
El CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
1:1 REMODEL L2--M`ULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE
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GARAGE E3 RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY RUCTION CODt) OCCUPANT
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w NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION AREA qT
-a I UNITS NUMBER REQUIRED LOAD
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DESCRIBE WORK TO BE DONE — I
REMARKS
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PROGRESS INSPECTIONS PER UEIC 108/FINAL INSPECTION REQ'D E
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit "eq5A City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
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LU PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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-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 pt 0
Recei
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 LandscapeInsp. Total Amt. Due 1�7
P,
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,' 1'�
MI Recording Fee Receipt #
1 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- CALL I his application is riot a punnit until signed by the
TION; AND IN DOING THE WORK AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial of hisihor Deputy. and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION 1� receipt Isacknowledged in space provided
ANCE AND RCW 18.27.
FFWIAj S SKWAI UHF DATE
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SIGNATURY (OWNER DATE SIGN (425)
771-0220 nrl (ASM'1311 6ATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL HLE Yf:LLO`iV INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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