940570.pdfs
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CITY OF EDMONDSUSE
ZONE PERMIT
NUMBER �- �QJO
CONSTRUCTION PERMIT APPLICATION JOB SUITE APT n
OWNER NAME NAME OF BUSINESS ADDRESS D . L'�LEGAL D SCRIPTION CHECK SUBD2,q;
NO uD NO
W MAILING AD RESS ,ryJ
O 'A `' PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved ❑
CITY ZIP TELEPHONE NUMBER
EXISTING REQUIRED DEDICATION RW Permit Required ❑
rl -MCI� ,- h- Street Use Permit Req d ❑
U PROPOSED Inspection Required ❑
NAME Sidewalk Requited ❑ IT
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Mr:T[R SIZE LINE SIZE NO OF FIXTURES PRV REQUIRED L
w ADDRESS vES ❑ NO ❑ 3
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U REMARKS z
< CITY ZIP TELEPHONE NUMBER W
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NAME W
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¢ ADDRESS
U , , -. ENGINEERING MEMO DATED REVIEWED BY
M CITY / ZI TELEP ONE NUM R
FIRE MEMO DATED
.i REVIEWEDBY W
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STATE Lif ENSE NU MBE EXPIRATION DATE LL
ZSIGN AREA SEPA REVIEW ADB NO
RA -ALLOWED PROPOSED COMPLETE EXEMPT
Legal escription OuTsof Pr perty - include all easement
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SHORELINE M
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EXP
U VARIANCE OR CU PLANNING REVIEW BY DATE
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-� SETBACKS —FEET HEIGHT LOT COVERAGE
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J Property
FRONT SIDE REAR z
Tax Account ) REMARKS a
Parcel No. L� c�
NEW RESIDENTIAL ,,/PLUMBING
ADDITION COMMERCIAL i _J MECHANICAL
ZGJ REMODEL 1:1APT. BLDG. El SIGN
GRADING FENCE CHECKED BY TYPE OF CONSTRUCTION CODE^ OCCUPANT
REPAIR CVDS. I. X_FT) p'� GROU
DEMOLISHWOODSINSERT
SWIM POOLa HO TUB SPA SPECIAL INSPECTOR AREA G / OCCUPANT
REQUIRED LOAD
GARAGE RETAINING WALL/ ❑ YES
CARPORT ROCKERY RENEWAL REMARKS
a(TYPE OF USE. BUSIN s OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305 z
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¢
w NUMBER NUMBER OF CRITICAL m
o OF I DWELLING AREAS
mUNITS 0 STORIES NUMBER
DESCRI E WORK TO BE DONE (ATTA H PLOT PL�DI�
1� 6 FINAL INSPECTION REQUIRED
A Z T VALUATION FEE
PLAN CHECK FEE
Z mill BUILDING
HEAT SOURCE ^ GLAZING
v
PLUMBING
Plan Check No. MECHANICAL %
This Permit covers work to be done on private property ONLY. GRADING/FILL !�
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
N 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
< 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
o nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision." (�
I hereby acknowledge that I ha ead this application; that the ATTENTION APPLICATION APPROVAL
information given is correct; a that l am th ner, or the duly
authorized a ent of the ow r. I agree t omply with city and THIS PERMIT This application is not a permit until
state laws�-rr latin ction; aPPd i d ng the work authoriz AurFloRlzes
ed th by. son Wi be empI V d i violation of the Labor ONLY THE signed by the Building Official or his/her
Co of th at
of Was ingt n �I ng �tNorkmen's Compensa• WORK NOTED Deputy; and fees are paid, and receipt is
do Insur a and RC 18. / INsPEcrlor� acknowledged in space provided.
SIGNAT 5lNER OR AG NTI GATE SIGNED DEPARTME04T
/ CITY OF OFFI IAL,/51 NATURE DATE
EDMONDS 1J1 edzq�
ATT O CALL FOR LEASED DATE
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� 0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ORIGINAL — File YELLO:"! — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — 0986^,Ar
GOLD — Assessor 10247
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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:
Gas Test ................. ti
Gas Piping, . .
Equipment...
Commercial Final.........
EXTERIOR SHEATHING
NAILING.., 6 1 1 1 1 1 4 1 0 a
FRAMING ....................
INSULATION:
Floor insulation ..........
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
RADON MONITOR AT SITE .
FINAL APPROVAL �c
FOR OCCUPANCY......���
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