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DATE RECEIVED FP ERMIT EXPIRES 2);'_' 12
USE PERMIT
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CITY OF EDMONDS NUMBER —0j0 3_
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNE NA E/NAME OF BUSINESS E,5-0 2 - _�� P /�)
/Lt-7 PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
cc MAILING ADDRESS LID FEE S
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3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit RoqLAIrod 0
0 A M__ 20x z 41� Street use Permit Heq'd 13
CITY ZIP TELEPHONE EXISTING — PROPOSED inspection flornilled 13
Side*alk Required E3
REQUIRED DEDICATION— FT underground
wiring required [3
NAME METER SIZE LINE SIZE 0. OF FIXTURES PRV REQUIRED
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L) OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE G
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE H gi�ay REQ'D POSTED
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< PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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[Q/NEW RESIDENTIAL 211*'PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FF.)
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COMPLIANCE OR z
ADDITION ERCIAL z
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PARKING PLANNING REVIEWED BY DATE 5
REMODEL VUMLTIFA ILY SIGN REO'D I PROVIDED
REPAIR GRADING FENCE - 17
CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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OF DWELLING AREAS -7- SPECIAL INSPECTION JAREA OCCUPANT
M UNITS NUMBER REQUIRED LOAD
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
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VALUATION
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7- Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing IZZ2 Base Fee
Mechanical /—I -zc'
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN JCURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMITI 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
U)
!I 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 Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC rI_Y OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHAI.L NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due L Cl
x 0 NOR Limi r IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; HIAT THE INFORMANON
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGRI�E TO .11 CITY AND STATE LAWS REGULATING CONSTRUC- I his application is not a pernlit until Signed by the
COMPLY V REBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and
TION AND IN DOING THE WORK HORIZED THE CALL
IN VItOLATION it 13OR WDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION tecLipt is acknowledged in space provided.
WORKME MP SATION Y6URANCE AND RCW 16,27. OFFICIAI.§,SIG URF DATE
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sl 4VKR - =OWNER R DATE SIGNED (425)
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771-0220 DAIE
A#ENTIONV EXT 1333
ItA UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU. (KIGIN�L FILL YEI-LOW/lNs4CTOR 7
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PIINK�JWNER 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:
Ir
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
62ov- 06 31f 80�
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