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EXPIRES
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATIIJT�DATE CHI
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
53:�' RESIDENTIAL ;R) PLUMBING / MECH
ADDITION
COMMERCIAL Ej COMPLIANCE OR
CHANGE OF USE
REMODEL
APARTMENT SIGN
REPAIR
GRADING F ENCE
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TANK OTHER
GARAGE
RETAINING WALL RENEWAL
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110NI NUMBER )409
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ADD;�EF,S Cc, �f -T— k, Q, 0 uo
PLAT NAIM F �SUPDIW SION �40 LOT NO LID NO,
LID FEE S
7ESCP Approved
PUBLIC RIGHT OF WAY FEE
I OFFICIAL STREET MAP
SW Permit Requ,red
Street Use Permit Reqj
EXIST:NG - PRDPOSED
inspection Required 0
SideNal� Requ-red C1
REOUIREDDEDICArION__
FT
UndelgrOLind
Wring requited 0
%IETER SIZE
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NO� OF FIXTURES
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PRV REQUIRED
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YES 0 NO 0
REMARKS
OWNERiCONTRACTOR RE�PONSIBLE FOR EROSION CONTROL/DRAINAGE
tENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
BY
SEPA REVIEW
COMPLETE EXEMPT
EXP 4 1.
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STED DAII E
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.
Cr. PERMIT APPLICATION: 180DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Ln 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCLSORS
w IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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n EDMONDS. WASHINGTON. ITSOFFICIALS EMPLOYEES, ANOAGENTSFROM ANYAND
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC I LY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCEANY REQUIREMENT OFANYC11YORDINANCE
_j NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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I HEREBY ACKNOWLEDGE T14AT I HAVE READ I HIS APPLICATION, THAr I HE INFORMATION
GIVEN IS CORRECT ' AND THAT I AM THE OWNER, OR THE DULYAUTHORIZED AGCNT O�:
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULArING CONS TRUC
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON VVILL BF EMPLOYi [)
IN VIOLATION OF THE LABOR CODE OF T14E STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCt.V iS 21
SIGNATURE i[OWN I EF)RLGIN.T_�, DAN� SIGNED
CHECKEDBY IT
SPECIAL INSPECTO;
REQUIRED F-� YES
REVIEWED/DATE
SHORELINE OR ADB4
SIGN AREA
ALLOWED . PROPOSED
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DATE
INSPECTION BOND
REO'D POSTED
0 YES 0 NO
HEIGHT
ALLOWED - PROPOSED
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REMARKS 121
1PROGRESS INSPEC�IONS PER UBC 108/FINAL INSPECTION REQ'jD0
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Al'TENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY H.�S BE�N GRANTED. UBC SECTION 109
5 q2
VALUATION
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BUILDING
PLUMBING
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LANDSCAPING
INSPECTIONFEF
P� AN CHECK DEPOSIT � I RECEIPT
IOTAL A%�CLJNI DUE
CALL
FOR INSPECTI)N
(425)
771-0220
EXT 333
771-0221
FAX
FEE
CEIPT
APPLICATION APPROVAL
I nis application is not it permit until Signed by Ine
Building Official of hislher Dopuly and Fees are paid,and
receip! sacknowledged in space provided.
Aj�
OF IC �,�qSIGNATUR
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LEASED BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK, OWNER GOLD - ASSESSOR
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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:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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