950220.pdfr
CITY OF EDMONDS r�
CONSTRUCTION PERMIT APPLICATIONJ170NI
OWNER NAME NAME OF BUSINESS DRESS U
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STATE LICENSE NUMBER
Legal Description of Property -
Pro,
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TELEPHON
7
RIGHT OF WAY PER OFFICIAL STREET MAP
G REQUIRED DEDICATION
TESCP Apprgvetl ❑
R W Permll Requuatl ❑
Street U9e Parmll Raq'tl ❑Inspeclion Requuatl ❑—Sidewalk Required ❑ER
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512E
LINE SIZE
NO. OF FI%TURES
PflV REQUIRED(�'YES ❑ NO ❑CS
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ELEPHONE
EXPIRATION DATE
all easements
LJ NEW 1:1RESIDENTIAL O PLUMBING
ADDITION El COMMERCIAL 1j-1j MECHANICAL
REMODEL ART. 13LDG. LJ SIGN
REPAIR ❑ GRADING cYDS ❑ PENCE ._Fr)
DEMOLISH ❑ INSERT
STOVE ❑ HO TU8OL
SPA
F-] GARAGE
CARPORT II ROCKERYG WALL/ ❑ RENEWAL
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBk WORK TO BE DONFn IATTACH PLOT PLAN)
10
ENGINEERING MEMO DATED REVIEWED BY -
FIRE MEMO DATED REVIEWED BY I
SIGN AREA SEPA REVIEW A08 O.
ALLOWED ,I PROPOSED COMPLETE EXEMPT
N*REA1—
/ SHOR NEM
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VARIANCE R CUW BY ATE
SETBACK —F ETIGHT LO CO ERAE��FRONT SIDS REMARK5
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CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPANT G
GR UP
SPECIAL INSPECTOR AREA / OCCUPANT (,
REQUIRED LOAD f
OYES
REMARKS
PROGRESS INSPECTIONS PER UBC 305
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FINAL INSPECTION REQUIRED
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VALUATION
FEE
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PLAN CHECK FEE
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BUILDINGden
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HEAT SOURCE'.
GLAZING
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/ 7,1 %
PLUMBING
Plan Check No. C �_� �/
MECHANICAL
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This Permit covers work to be done on private properly ONLY.
GRADINGIFILL'
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Any construction on the public domain (curbs, sidewalks,
driveways, marquees, etc.) will require separate permission.
STATE SURCHARGE
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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
ENO. INSPECTION FEE
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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
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
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nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
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provision."
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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
APPLICATION APPROVAL
aulhorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and In doing the work authoriz•
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the State of Washington relating to Workmen's Compensa.
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
SIGNATURE (OWNER OR AGENT( DATE SIGNED
DEPARTMENT
CITY OF
OFFICIAL'S SIGNATURE DATE
EDMONDS
CALL FO REL DY DATE
ATTENTION INSPECTION �i
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE 771-0220 %�J
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 7 ORIGINAL — File YELLOW —Inspector s--'-
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC 0
CHAPTER 3. PINK — Owner GOLD — Assessor F
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVE
SETBACKS ...................
FOUNDATION:
• Footing ....................
Wall .......................
Pier/Porch ................
Retaining Wall............
Slabinsulatlon............
PLUMBING:
Underground .............
Rough -In ..............
....................
��-•��
Commercial Final ........
HEATING:
Gas Test .................
Gas Piping ................
Equipment ................
Commercial Final.........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ...................
INSULATION:—�
Floorinsulation...........
Wall Insulation ........
Ceiling Insulation.........
�---.
' SHEETROCKNAILING �'
• SPECIAL INSPECTION ......
RADON MONITOR AT SITE.
FINAL APPROVAL 2 Z FOR OCCUPANCY..........