950185.pdfCITY OF EDMONDS USE
PERMIT
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CONSTRUCTION PERMIT APPLICATION ,Dd 999 SUITE APTD
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w ADDRESS YES ❑ NO ❑
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a CITY ZIP TELEPHONE NUMBER
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NAME
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O ENGINEERING MEMO DATED REVIEWED BY
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S E l.I (:F NSI: NIIMItEn EXPeIIR�ATION DATE
�ZV SIGN AREA SEPA REVIEW ADD NO
Legal Description Of Propefty - include all eas ments ALLOWED PROPOSED COMPLETE JEXEMPT
SHORELINEp
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VARIANCE OR Cu PLANNING REVIEW BY DATE
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SETBACKS — FEET HEIGHT LOT COVERAGE
FrgPedy FRONT SIDE REAR a
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RESIDENTIAL PLUMBING
AUIIItJN COMMERCIAL Q NICAL
d1D:MOOEI ❑ APT. SLOG. ❑ SIGN
GRADING CYDS. � ENCE K—� CHECKED BY TYPE OF CONSTRUCTION CODE/ / CRCOUPANT
dEVAIn `/J 3
DEMOLISH ❑ WOODSTOVE ❑ SWIM POOL SPECIAL INSPECTOR AREA OCCUPANT
INSERT HOT TUB/SPA REQUIRED LOAD
❑GARAGE RETAINING WALL/ I] YES
CARPORT ROCKERY RENEWAL REMARKS
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: PROGRESS INSPECTIONS PER UBC 305
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,N NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
Q STORIES UNITS NUMBER
-' DESCRIBE WORK TO BE DO (ATTACH PLOT P NI
1` FINAL INSPECTION REQUIRED
I, VALUATION FEE
2-PLAN CHECK FEE �j
HEAT SOURC GLAZING BUILDING `/�
�� 0/0 PLUMBING �Jv
Plait Check No. MECHANICAL
This Permit covers work to be done on private property ONLY. GRADINGIFILL
Any construction on the public domain (curbs, Sldewe-lks,
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
m successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
s employees, and agents from any and all claims for damages of
a 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 APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree comply with City and THIS PERMIT This application is not a permit until
state laws regulating construction; and n d ing the work authoriz. AUTHORIZES
ad thereby, no per w+,v' a employed I violation o1 the Labor ONLY THE signed by the Building Official or his/her
Code of the S of W ngfOrr'ielating Workmen's Compensa- WORK NOTED Deputy; and lees are paid, and receipt is
lion Insur ce and INSPECTION
acknowledged in space provided.
SIGNAT EIOWNER ) re02SIGN ND� DEPARTMENT
CITY OF OFFIGIA S SIG NATUR� DATE
i
EDMONDS
ATTENTION
CALL FOR RELEASED BY
INSPECTION DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE _0ION
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 7 INSPECTION
l LL ORIGINAL — File YELLOW —Inspector /
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3. PINK — Ov:.ner GOLD — Assessor
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall .......................
Pier/Porch................
Retaining Wall............
Slab Insulation ............
PLUMBING:
Underground .............
Rough -In ....... I.........
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.........: