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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME NAME OF BUSINESS IF
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ZMAILING ADDRESS
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NAME
CITY
NAME
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NE NUMBER
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CITYZIP TELEPHONE NUMBER
SGA 01g 1 i z)l
1 STATE LICENSE NUMBER A--- EXPIRATION DATE
n of Property - include all easements
Tax Account
Parcel No. ( CilI\14 LLJJ
NEW RESIDENTIAL tz PLUMBING
ADDITION COMMERCIAL MECHANICAL
REMODEL APT. BLDG. SIGN
REPAIR ElGRADING❑ FENCE
CYDS. ( X_FT)
DEMOLISH � NQORTTOVE SWIM POOL
HOT TUBSPA
GARAGE RETAINING
CARPORT ROCKERY WALL/ ❑ RENEWAL
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
JA C`I 7A1 a r�11,2. Al A iLe �L
ZONE
JOB
ADDRESS
PERMIT 0407
NUMBER �•1
SUITE/APT a
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
TESCP Approved ❑
RW Permit Required ❑
EXISTING REQUIRED DEDICATION
Street Use Permit Req-d ❑
PROPOSED
Inspection Required ❑
Sidewalk Required ❑
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METER SIZE
LINE SIZE OF FIXTURES
PRV REQUIRED
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YES ❑ NO ❑
3
iEMARKS
2
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ENGINEERING MEMO
REVIEWED BY
SIGN AREA SEPIA REVIEW ADB NO.
ALLOWED PROPOSED COMPLETE EXEMPT
SHORELINE
EXP
VARIANCE OR CU PLANNING REVIEW BY DATE
SETBACKS — FEET I HEIGHT I LOT COVERAGE
FRONT SIDE REAR
U
SPECIAL INSPECTOR AREA OCCUPANT
REQUIRED LOAD
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
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rPermit Application::r DaysFEE
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$Applicant, on behalf of his or her spouse, heirs, assigns and 1 �14211cs "QUIxotalah"
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
tiemployees,. agents from. all claims fordamages
• whatever
• of permit shall notbe deemed toI
'S modify,reduce any of any city
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• • • • • �3TOTAL AMOUNT
provision.
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��TURE (0�yiltrq EN DATE SIGNED
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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.
10IAI_ S SIGNATURE A / DATE
Wt•:
DATE
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AN IL A FINAL INOFE TION HAS
OCCUPANCY HAS ABDE EENN GRANTED.VA UBC OR 771 � ®22® ORIGINAL — File YELLOW — Inspector
CHAPTER 3. PINK — Owner GOLD — Assessor
102.87 0
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RECORD
OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS.....,,,
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FOUNDATION:
Ft
Footing�.
f'•
Wall.......................
Pier/Porch ............
Retaining Wall............
Slab insulation
............
PLUMBING:
Underground'...
Rough -In
.................
Commercial Final
........
HEATING:
Gas Test .................
Gas Piping ................
Equipment ................
Commercial Final.
EXTERIOR SHEATHING
NAILING..,,
FRAMING
....................
INSULATION:
Floor Insulation...........
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING
......
SPECIAL INSPECTION
......
RADON MONITOR AT SITE.
FINAL APPROVAL
FOR OCCUPANCY........ tQ
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