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DATE RECEIVED
_71 fi) PERMIT EXPIRES
USE PERMIT
70NE
CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
, 4 < LID FEE $
MAILING ADDRESS
—7 TESCP Apptov;d 13
A�' PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required Q
0 Street Use Permit Raq*d E3
CITY EXISTING PROPOSED Inspection Required Cl
ZIP TELEPHONE Sidewalk Required [3
REQUIRED DEDICATION. FT Underground
Wiring required E3
2- J006, S7# 0'ell�l
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO 0
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L- ADDRESS REMARKS z
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE F3
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/510WAISI Alle-c" 1734-_-,� 5 -1 FIRE REVIEWED BY DATE
CITY ZIP TELEPHONE M
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION ROND
'XPIRA 0 TE REQ'D
STATE LICENSE NUMBER EXPIRA ION DATE CHECP 13Y POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
_j COMPLETE XEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL i�LUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
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GRADING FENCE X FT) REMARKS
REPAIR ED CYDS E] (
El DEMOLISH 13 TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED 13Y ITYP2MC NSTRUCT ON CODF OCCUPANT
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U1 NUMBER I NUMBER OF CRITICAL OCCUPANT
OF If DWELLING JAREA
AREAS ��/
_/,/ I SPECIAL INSPECTION LOAD
UNITS NUMBER REQUIRED
0 STORIES YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D 3
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VALUATION
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I7,rm j Description FEE Description FEE
t, I;33;zzz:4z F-, i roll
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CH "C Plumbing
VESTED DATE
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 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ul PERMIT APPLICATION: 180DAYS
0. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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W IN INrEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FHOM ANY AND Fire Inspection Receipt #
IM
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT IY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHAI 1. NO I HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMEN r OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt P
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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, CALL I his application is riot a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial or his/tier Depulyi and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATIQ�N�R�,NCE AND RCW 18 27. (FF1 9IG URE DATE
ED //"-,
SIGNATUR (OWNER G' N DATE sl (425)
771-0220 LEXf-D 131 T
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ATTENTION EXT 1333 7
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- 0111GINAL FILE YEI.LOW/INSPeCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
GRFEN ACCOUNTING
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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 3 -3z,
..................
OCCUPANCY
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