950232.pdfl;
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE NUMBER 950a32
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JOB
OWNER NAME/NAME OF BUSINESS
ADDRESS L /11
etjTE/APT N
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LEGAL DESCRIPTION CHECK
SUSDIVRION NO.
LID NO.
O
MAILING ADDRESS
(413, / — V -_,Qb
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP.
EXISTING REQUIRED DEDICATION
TESCP Approved ❑
RW Permit Required ❑
Meet Uae Permit Req'd ❑
CIT ��.{1I -ZIP TELEPHONE NUMBER
— `/�(
C V,
VVV
VVV
PROPOSED
lneP-tlan Required ❑
Sidewalk Required ❑
NAME
METER SIZE
LINE SIZE
NO.OF FI%7URES
PRV REQUIRED g
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YES ❑ NO ❑ yC
ADDRESS
U
RC -MARKS Z
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a
CITY ZIP
TELEPHONE NUMBER
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VE
ADDRESS
ENGINEERING MEMO DATED REVIEWEOBY
O
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CITY ZIP
TELEPHONE NUMBER
2
FIRE MEMO DATED REVIEWEOBY
O
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STATE LICENSE NUMBER EXPIRATION DATE
SIGN AREA
ALLOWED PROPOSED.
SEPA REVIEW
COMPLETE EXEMPT
ADS NO.
Legal Description of Property - include all easements
_
SHORELINEN
O
a
EXP
—
H
VARIANCE OR CU
PLANNING REVIEW
BY DATE
0
SETBACKS —FEET HEIGHT
LO7 COVERAGE _
M'
FRONT'. SIDE REAR
i
Property
Tax Account
Pamel No.
REMARKS 5
NEW �- RESIDENTIAL PLUEl MBING
ADDITION O COMMERCIAL MECHANICAL
�I�l
REMODEL APT. BLDG. LJ SIGN'
CHECKED BY
TYPE OF CONSTR�U\CTION .CODE
21
OCCUPANT
/\ P 3
REPAIR ❑ GRADING CY05. PEX—FT)
n WOODSTOVE SWIM POOL
/YOEMOLISH INSERT HOT TUB/SPA
/
GAR GE RETAININ CARPORT CJ ROCKERY WALL/
❑ RENEWAL
SPECIAL INSPECTOR
REQUIRED YES
13
AREA
OCCUPANT
LOAD
REMARKS
0
(TYPE of USE. BUSINESS OR ACTIVITY) EXPLAIN:
PROGRESS INSPECTIONS PER UBC 305 s
o
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL i�
AREAS
NUMBER
-'
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED.
VALUATIONS
FEE
PLAN CHECK FEE
I.
BUILDING
HEATSOURCE
GLAZING
a/a
'
1
PLUMBING
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction On the public domain (curbs; sidewalks,
STATE SURCHARGE.
driveways, marquees, etc.) will require separate permission.
Permlt Application: 180 Days
Permll 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 Clty of Edmonds, Washington, Its officials,
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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
j 1.
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_.
PLAN CHECK DEPOSIT
omodify,
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
provision."
TOTAL AMOUNT DUE
-
Information
1 hereby acknowledge that I have read this application; that the
given Is correct; and that I am the owner, or the duly
ATTENTION APPLICATION APPROVAL
tion
authorized agent of the owner. I agree to comply with city and
slate laws regulating construction; and In doing the work authoriz•
ed Ihereby, no person will be employed In violation of the Labor
Code of the Stale of Washington relating to Workmen's Compensa•
Insurance and RCW 18.27.
THIS PERMIT This application is not a permit until
AUTHORIZES
ONLY THE signed by the Building Official or his/her
WORK NOTED Deputy; and fees are paid, and receipt Is
INSPECTION acknowledged In space provided.
DEPARTMENT
SIGNATUR
CITY OF OFFICI DATE
EDMONDS
CALL FOR R EASED DY: DATE
INSPECTION
-
SI
TURE (OWNER OR AGENT) DATE SIGNED
ATTENTION
IT
UNT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220IL ORIGINAL — File YELLOW — Inspector
A
CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER
3.
PINK — Owner GOLD — Assessor
y
10247
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .................. .
FOUNDATION:
Footing....................
Wall.......................
Pler/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:
Floor Insulation...........
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
RADON MONITOR AT SITE.
FINAL APPROVAL,,."'� 4k" • ry ��
FOR OCCUPANCY.... (� C
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