950211 (2).pdfY
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE NUMBER
OB SUITE APT+
ADDRESS
OWNER NAME NAME OFF BUSINESS
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LEGAL DESCRIPTION CHECK SUBIJ-s
ON NO
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-AILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING_ REOUIRED DEDICATION____
PROPOSED -
TESCP ApplaveG ❑
RW Perm1l Requited ❑
SI-, Ufe Perm,l Reu d ❑
IPSPBPIIUP Required ❑
Sidewalk Req-ed ❑
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TEL EPHONE NUMBER
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NAME
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METER SIZE
I LINE SIZE
ND OF FIXTURES
PRV REQUIRED
YES ❑ NO ❑ �'
ADDRESS W S
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REM�BKS .`'I
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CITY ZIP
TELEPHONE NUMBER
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NAME
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ADDRESS
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ENGINEERING MEMO DATED REVIEWED BY
CITY ZIP
TELEPHONE NUMBER
FIRE MEMO DAZED REVIEWED 6Y
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STATE tiCENSE NLIMBER EXPIRATION DATE
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE JEXEMPT
ExP-91
ADD NO
SHORELINE e
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Legal Description of Property - include all easements
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aC4 5'c- --CT OL - 00I. - 01 617
VARIANCE OR CU
PLANNING REVIEW
BY DATE
SETBACK$ - FEET HEIGHT
LOT COVERAGE 2
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FRONT SIDE REAR
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Property 4 3 4 6" O iD Z -0 l j- 0001.
TaxeccpUnl
Parcel No. / se.S6 •, UO'Z a0
REMARKS
NEW a RESIDENTIAL PLUMBING
D ADMITION COMMERCIAL El MECHANICAL
REMODEL APT. BLDG. LJ SIGN
CHECKED BY I TYPE O_ CONSTRUCTION CODE
M
GROUP
GRADING FENCE
REPAIR Cv05 I_x__FT)
SWIMPOOL
EAIOLISM ❑ INOOgT TOVE NOT UB SPA
GAD
ARAGE ❑ RETAINING WALL/ ❑
CARPORT ROCKERY RENEWAL
SPECIAL INSPECTOR AREA
REQUIRED
YES
OCCUPANT
REMARKS
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PROGRESS INSPECTIONS PER UBC 305 O
(TYPeyF s�guslN ss oR ACTIwTn ExPLAw.
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NUAIDER
OFAREAS
NUMBER OF ^/
WELLING
UNITSLING UNe
CRITIC,AL9^7
NUMBER / ✓-V /
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PLOT N)
DESCRIBE WORK TO BE CONE (ATTACH
FINAL INSPECTION REQUIRED
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VALUATION
FEE
PLAN CHECK FEE
BUILDING
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IIEA1 SOURCE
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L�AZING
G.y�
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PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY,
GRADINGWILL
Any construction on the public domain (Curbs, sldewRiks,
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 1Year -Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages of
END. INSPECTION FEE
PLAN CHECK DEPOSIT
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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
modify, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
TOTAL AMOUNT DUE
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. I agree to comply with city and THIS PERMIT
slate laws regulating construction; and in doing the work authoriz• AUTHORIZES
ed thereby, no person will be employed in violation of the Labor ONLY THE
Code of the Stale of Washington relating to Workmen's Compensa• WORK NOTED
tion Insurance and RCW 18.27, INSPECIION
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.
SIGNATURE iO,VNER OR AGENT) DATE SIGNED DEPARTMENT
CITY OF GF
W C ry�Q v yYYt : I 3C) c�S EDMONDS
I IA S 51 4TURE DATE
- 1
CALL FOR �El
ATTENTION INSPECTION
/ Ze/•- DATE
e, J -IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE����O�G®
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
ORIGINAL - Foe YELLOW - In5peCldr
A L.CH—.iZA E Vr vCCL;FmN,, nno occlN .Ann,.,
CHAPTER 3.
total
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PINK - 0Wr,er GOLD - Assessor
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MELON
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1411
RECORD OF INSPECTIONS
INSPECTOR .DATE APPROVED
SETBACKS...
FOUNDATION:
Fooling ....................
Wall .......................
Pier/Porch................ -
Retaining Wall............ -
Slabinsulation............
PLUMBING:
Underground .............
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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.
FPROVAL
FOROCCUPANCY
OCCUPANCY
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