940498.pdfr
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME PF BUSINESS i
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ADDRESS
CITY
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ADDRESS
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CITY
STATy'LiCENSE� NUMBER
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ZIP
ZIP ITELEPHONE NUMB
TELEPHONE N
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ZONE PERMIT
NUMBER 946498
JOB ADDRESS SUITE!APT «
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LEGAL DESCRIPTION UHLUKI SUBDIVISION NO ILID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP,
TESCP Approved ❑
EXISTING REQUIRED DEDICATION
RW Permit Required ❑
Street Use Permit Req'd ❑
PROPOSED
Inspection Required ❑
Sidewalk Required ❑
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES ❑ NO ❑
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1EMARKS
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ENGINEERING MEMO DATED
EXPIRATION DATE
/Zz SIGN AREA
erty -include all easements-1ALLOWED I PROPOSED
Tax Account
Parcel No. - S .�
NEW RESIDENTIAL PLUMBING
ADDITION 11 COMMERCIAL MECHANICAL
OJ REMODEL 1:1APT. BLDG. El SIGN
REPAIR a GRADING CYDS I FENCE x_
FT)
DEMOLISH WOODSTOVE SWIM POOL
INSERT HOT TUB/SPA
GARAGE RETAINING
CARPORT ROCKERY WALL/ RENEWAL
TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
i NUMBER I NUMBER OF INUMBER
CRITICAL
OF DWELLING AREAS
STORIES UNITS
' 0 SC%'BE WORK TO BE DONE (ATTACH PLOT PL I
VARIANCE OR CU
SETBACKS —FEET
FRONT SIDE
REVIEWED BY
SEPA REVIEW I ADS NO.
COMPLETE IEXEMPT
EXP I I
PLANNING REVIEW BY I DATE
HEIGHT LOT COVERAGE Z
i
REAR 5
a
rUl
ECTOR AREA % OCCUPANT
LOAD
❑ YES
SS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEE
HEATSOURCE � GLAZING BUILDING
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
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days STORM DRAINAGE FEE
"Applicant, on behalf of his or her spouse, heirs, assigns and ENG. INSPECTION FEE
In successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds, Washington, its officials,
m employees, and agents from any and all claims for damages of
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whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to PLAN CHECK DEPOSIT
omodify, waive or reduce any requirement of any city ordinance
x 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
information given is correct; and that I am the owner, or the duly ATTENTION
authorized agent of the owner. a to omply with city and THIS PERMIT
state laws re ling constru on; an in ng the work authoriZ• AUTHORIZES
ed thereb er ll a emplo i violation of the Labor ONLY THE
Code h of Wa CZ
Code rel g Workmen's Compensa• WORK NOTED
tion I Sur nd RC 8.27. iNSPECTiOo+
SIGNAT .ER OR AG NTI DATE SIGNED DEPARTME�+T
2! CITY OF
EDMONDS
J4TTE O CALL FOR
INSPECTION
IT IS UN FUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
(f)
I G:;i3 P&t
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.
OFFICIAL SIG T RE DATE
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RELEASED BY DATE
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ANTIL CERTIFICATEA FINAL INOFECTION O CUPA HAS CYE EN HAS ABEENDE " GRANTED. UBC 771 L OR_ 0220 ORIGINAL — F le YELLOW —Inspector
CHAPTER 3. PINK — Ov.rer GOLD — Assessor
102417
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INSPECTOR
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RECORD OF INSPECTIONS
DATE APPROVED
SETBACKS,,.,,.., .
FOUNDATION:
Footing ....................
Wall....
Pier/Porch................ `l
t
Retaining Wall............
Slab Insulation.
PLUMBING:
Underground ............ .
Rough -In .................
Commercial Final ........
HEATING:
Gas Test ................ .
Gas Piping.. , .
Equipment .:..............
Commercial Final .........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floorinsulation ...:..::..
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
++; SPECIAL INSPECTION ......
RADON MONITOR AT SITE .
FINAL APPROVAL
FOR OCCUPANCY.........,. 1 6