950400.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE
PERMIT
5IZ NUMBER 95'04ng
OWNER NAAtI: NAME Of BUSINESS / / /
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ADDRESS >,%� �/I w/ lS
LEGAL DESCHIPi,IJON CRECK
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LID NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING _.._. __._._ HEOUIRCp DEOICAiION __.....__..._
PIIOPOSED ....___._
TESCP Approved ❑
HW Pclmtl Recilnmd ❑
Steel Uec Permit Req U ❑
Infp,,Oon Regweptl ❑
Sldownik Rpgweeel ❑
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TELEPHON[NUMBER
NAME
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REMARKS YES ❑ NO ❑
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< CITY ZIP
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TELEPHONE NUMBER
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NAME
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ENGINEERING MEMO DATED REVIEWED BY
SllLT�LIr�NSE NUAIDEIi C, v---� EXPIRATION DATE
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'NV `� �'5'<_ SIGN AREA BEPA gEV1EW
Legal Description of Property - include all easements ALLOWED 4pll.,..ED
I COMPLETE E
EXP 4
ADS
VARIANCE O CU L IG I -BY ATE
SETBACK /n��ET �/�
III HEIGHT LOT COVERAGE/
Property O� (/ /'�
eX TAccount 7 V
Parcel No.i
FRONT SIDE \/ REAR '
REMARKS
r�l RESIDENTIAL
ApnI ITUN COMMERCIAL
J�J REMODEL APT. BLDG.
REPAIR ❑ GRADING
CYDS
STOVE
El DEMOLISH ❑ INSERT
GARAGE RETAINING WALL/
CARPORT ROCKERY
PLUMBING
�l�II MECHANICAL
LJ SIGN
FENCE x—�
HO TUBSPA
RENEW
CHECKED BY
TYPE OF C STRUCTION
_
CODE s
RSPECIAL EQUIRED INSPECTOR I AREA
YES
REMARKS
PROGRESS INSPECTIONS UBC 305
(TYPE OF USE. BUSIIJESS OR ACTIVITY) EXPLAIN:,(yam-
r 1
/PER
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[XII�� G G �L /L /� ',� G1IS/
NUMBER
STORIES
DESCRIBE WORK TO BE DONE
NUMBER OF �r
DWELLING /)/r
UNITS
IATTACH PLOT PLANT
CRITICAL
NUMBER �J
_
LOAD
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FINAL INSPECTION
REQUIRED
✓S C r
VALUATION
FEE
n �i
!% 19
PLAN CHECK FEE
HEAT SOURCE
OLAIINI /
BUILDING
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l? / 611 - / )
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ere
PLUMBING
Plan Check No. !S 1174
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewalks,
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
Isuccessors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
i
a employees, and agents from any and all claims for damages of
whatever nature, arising directly or Indirectly from the issuance
x of this permit. Issuance of this permit shall not be deemed to
modify, waive or reduce any requirement of any city ordinance
i nor limit in any way the City's ability to enforce any ordinance
provision."
4
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
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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
authorized agent of the owner. I agree to comply with city and
stale laws regulating construction; and In doing the work authoriz
ATTENTION
THIS PER
AUTHORIZES
APPLICATION APPROVAL
This application is not a permit until
ad 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
lion Insurance and RCW 18,27.
INSPECTION
acknowledged in space provided.
SIGNAT RE WNER OR gGENTI ^ DATE SI /NE/O
(/
n
DEPARTMENT
CITY OF
EDMONDS
O F I LS GrvATURE DATE _
7��'-�j
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CALL FOR
INSPECTION
��� �OGLo
R D DATE
c ,—
ORIGINAL — Flle YELLOW — Inspector
I
CHAPTER 9.
10287
PINK — 0•Acer GOLD — Assessor
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .. .. ...
FOUNDATION:
Footing
Wall.......................
Pier/Porch ................
.'.
_... -.>
i
Retaining Wall............
�
-
- � � � •
Slab Insulation............
T;
PLUMBING:
............
JUnderground
,. .: ;: ,., �,r.:� •.;.
Rough -In ...... I..........
Commercial Final........
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HEATING:
Gas Test_ ................
Gas Piping ................
Equipment.—_;' ........
Commercial Final.........
EXTERIOR SHEATHING
NAILING ....................
FRAMING'
' -r '�•� TJ `/ T— '���... '.
-
.... :..........
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-. i;.'.
INSULATION:
Floor Insulation ..........
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Wall Insulation ...........
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Ceiling Insulation........,
SHEETROCK NAILING
....,�t'� . �' Z Z • %'$�
SPECIAL INSPECTION
......
RADON MONITOR AT SITE.
FINAL APPROVAL
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FOR OCCUPANCY.....
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