20051073.pdfDATE RECEIVED A PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER CHJTCIADT #
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MAILING ADDRESS I LID FEE $
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z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required CI
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0 Street Use Pounit Roq'd CI
C�;y ZIP T�LPPHONE EXISTING — PROPOSED Inspection Requirad E3
Sidewalk Required E3
REQUIRED DEDICATION-- FT Underground
7.e Wiring required E3
NAME METER SIZE LINE SIZE NO. OF FIXFURES PRV REQUIRED
YES 13 NO 13 z
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AGE a
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ansion tank shall be
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CBLO installed on all hot water tanks*
NAME 1 :7 Vq /
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ADDRESS
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- C� e�" FIRE REVIEWED BY
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MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE z
DATE
PARKING LOT AREA PLANNING REVIEWED BY
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REPAIR
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FIRE SPRINKLER
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OCCUPANT
GROUP
NUMBER
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SPECIAL INSPECTION
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NUMBER
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REMARKS
PROGRESS INSPECTIONS
PER UBC 1081FINAL INSPECTION RE01D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCt OLAZING % LOT SLOPE %
Building Permit
city Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
9 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 CLAJMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due (P
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
—
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Fee
Receipt # t
Recording
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION AF
GIVEN 13 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
This application is not a permit until signed,by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
Building Otficial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
DATE
OFF�=(
SIG�N IRE (OWNER G DATJJG *. �1
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771-0220.
--- DATE
RELEASEJ a Y
k(TfENTION
Off 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 -FILE YELLOW. INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU
ARE MAKING 5 COPIES
GREEN - ACCOUNTING
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ANSPECTOR DATE. APPROVED
SETBACKS .................. I
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Commercial Final .......
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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EXTERIOR SHEATHING
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FR AMING ...................
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FIRST FLOOR FRAMING...'
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INSULATION ....................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION
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171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ........... ......