930684.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME DAME OF BUSINESS
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CITY ZIP TELEPHONE NUMBER
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CITY ZIP TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
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Legal Description of Property - include all easements
�2 PLAT OF SftAlH-V9u6ef
Property �-^ �%
Tax Account yt{ J��� + oo 2 006 pC%O
Parcel No. �`�
NEW N RESIDENTIAL PLUMBING
ADDITION El COMMERCIAL MECHANICAL
REMODEL 1:1APT. BLDG. LJ SIGN
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GRADING ❑ FENCE
REPAIR CYDS. (_x_FT)
DEMOLISH WOODSTOVE SWIM POOL
LP INSERT El HOT TUB/SPA
GARAGE
CARPORT ROCKE YG WALL/ RENEWAL
(TYPE OF USE, BUSSIINpE1SS/�OpR_�ACTIVITY EXPLAIN: CA
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
USE PERMIT
ZONE F I NUMBER 93C)rj%ZZL
JOB j ^ t'� �^� /,� SUITE/APT q
ADDRESS
LEGAL DESCRIPTION CHECKI SUBDIVISION NO ILID NO
PUBLIC RIG�AY PER OFFICIAL STREET MAP.
EXISTING : REQUIRED DEDICATION
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REMARKS
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TESCP Approved
❑
RW Permit Required
❑
Street Use Permit Req'd
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Inspection Required
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Sidewalk Required
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ENGINEERING MEMO DATED
METER SIZE IBUILDI
REMARKS
SIGN AREA
ALLOWED I PROPOSED
VARIANCE OR CU
SETBACKS —FEET
FRONT SIDE
CHECKED BY
REQUIRED 11 YES
REVIEW BY
.Y SIZE NO. OF FIXTURES
Is
SEPA REVIEW ADS NO.
COMPLETE (EXEMPT
EXP I
PLANNING REVIEW BY
REAR
DATE
HEIGHT I LOT COVERAGE
GROUP
PROGRESS INSPECTIONS PER UBC 305
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T.,)MI1 )S LVL7vv F"�Xry FINAL INSPECTION REQUIRED
!'�►. ) &AizAol FONDA N VALUATION
{ PLAN CHECK FEE
BUILDING
HEAT SOURCE: GLAZING
/ % PLUMBING
Plan Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission, STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work is Started Within 180 Days .
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
o successors in interest, agrees to indemnify, defend and hold harmless the City o
3 f Edmonds, Washington, its officials,
employees, and agents from any and 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 PLAN CHECK DEPOSIT
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance TOTAL AMOUNT DUE
provision."
I hereby acknowledge that I have read this application; that the ATTENTION
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and THIS PERMIT
state ; regulating construction; and in doing the work authoriz• AUTHORIZES
Ed Vhere by, flio person will a employed in violation of the Labor ONLY THE
Code of the //State of Washi ton relating to Workmen's Compensa• WORK NOTED
tion Insur ACe. INSPECTION
SIGN TUR (OWNER OR AGENT) / i" DATE SIGNED DEPARTMENT
OF
/tAVIL ,�lr'="� 6,- DIMONDS
CALL FOR
ATTENTION INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 771-0220
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
1o2-e7
OCCUPANT
LOAD
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APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided,
OFF CIAL,'S SIIIGNAT RE DATE
ELEASED BY:
ORIGINAL
— File
YELLOW
— Inspec
PINK —
Owner
GOLD —
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Gt�L-�a��c-�tY
3 RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
't SETBACKS ..... `.' ...... -�"l ' ` -3 " 3 ..
FOUNDATION:
Footing ..
wall
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Pier/Porch ,t
Retaining Wall.......... 3 _...
PLUMBING:It
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Underground
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Rough -In ... ,map=7�
CF ;
HEATING. _
FfA✓(� Gas Test.. —
'6i�f Gas Piping ..........
Equipment.4 1 0 .........
s CF ........
FRAMING . • , . 411 ..... • 1 1 1
SHEETROCK NAILING . •`� ��1 G ' ��
} SPECIAL INSPECTION...
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FINAL APPROVAL
FOR OCCUPANCY
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