960178.pdfn
USE PERMIT CITY OF EDMONDS 2DNEl'Z NUMBER 9GOJ %
CONSTRUCTION PERMIT APPLICATION ,OB
`Ivuk'I+N•TAIE \AMI. t'1 BUSINESS ADDRESS g-%r ll - iliew
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� � � !IP if LEPNONE NUMBER
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77
CITY 21P TELEPHONE NUMBER
STATE LICENSE NUMBER EXPIRATION DATE
TDHIVSF�O OT5'D1(
Legal Description of Property - include all easements
55 «. 13 T__ E W7 \\Rre£ OS
PToA 13a7o3- 4—('jQ9 —OQoq�
P:rcelcount
Parcel No.
NiNEW
I,0) RESIDENTIAL
PLUMBING
ADOITION
COMMERCIAL
MECHANICAL
APT BLDG.
REMODEL
LJ SIGN
GRADING
❑ FENCE
O❑
CYDs
�REPAIR
DEMOLISH
STOVE
SWIM POOL
,INS
HOT TUB/SPA
GARAGE
RETAINING WALL/
CARPORT
❑ ROCKERY
❑ RENEWAL
(TYPE J SF.y� NESS OR ACTIVITY( EXPLAIN:
�/
NUMBB"R
OF I
rJUMBER OF
DWELLING
CRITICAL
AREAS
c TOMES
UNITS
NUMBER
DESCRIBE WORK TO
BE DONE
(ATTACH PLOT PLAN)
LEGAL DESCRIPTION CHECK
SUBDIVISION NO LID
NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP
RW
EXISTING _—_—_ REOUIRED DEDICATION ___ .___ S+ree1
PROPOSED Inepecl—
---"---'-- Sldew,
Approved ❑
Permd Renpned ❑
Use Permd neR d ❑
ReQu�Icd ❑
, ReRpecd ❑
MEIF.R SITE
LINE SIZE
NO OF FI%1UREs
PRV REOIIIRED
YES ❑ NO ❑
REMARKS
ENGINEERING MEMO DATED REVIEW En BY
,9cc-
FIREMEMO DATED ---By
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE JEXEMPT
/
EKP V
ADS NO
—
SHOREUNEI
VARIANCE OR Cu
PLANNING REVIEW BY
DATE
SETBACKS — FEET HEIGHT
FRONT Zr7 SIDE () r REAR
LOT COVERAGE
REMARKS
CHECKED BY I TYPE OF CONSTRUCTION
CODE
OCCU�Tj{T _
SPECIAL INSPECTOR
REQUIRED
❑ YE
AREA
eif
pGCUPANT
LOAD
EMARKS
PROGRESS INSPECTIONS PER UBC 305
FINAL INSPECTION REQUIRED
PLAN CHECK FEEBUILDINO
HFAT SOLI -E
GLAZINGA
pad
N
PLUMBING
Plan Check No. �(� .i 3�j
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.
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
,o successors In interest, agrees to indemnify, defend and hold
harmless the Cdy of Edmonds, Washington, its ollicials,
employees. and agents from any and all claims for damages of
whatever nature. arising directly or indirectly from the issuance
T of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
omodify. waive or reduce any requirement of any city ordinance
T nor lima 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
Of ormauon 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
state laws regulating construction: and in doing the work authorize
AUTHORIZES
ed thereby, no person will be employed in violation of the Labor
ONLY THE
Code of the Slate of Washington relating 10 Workmen's Compensa.
WORK NOTED
fion Insurance and RCW 18,27.
INSPECTION
SIGNATURE (OWNER OR�+\GEv`I DATE 51GNED
DEPARTMENT
q
' 3 —
TY OF
�1./
DIMONDS
CALL FOR
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� _0220
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER J. k /
+mar
i
APPLICATION APPROVAL
This application is not a permit until
signed by the Building Official or his/her
Deputy; and lees are paid, and receipt is
acknowledged in space provided.
ORIGINAL — File YELLOW — Inspector
PINK — Owner GOLD — Assessor
1. e
ON,
m
NTACT PHONE
1ECT ADDRESS
,luM of jmp-,o •(,2wr arivG,
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rKRl,I
TE AREA J5,745 5f
LOWABLE SrrE CDYEMGE 315 Y.
oPos vD covEn u" Sr w zor.
.GWED SETBACKS F 25' S 20' S lo' B N'
IOPOSED SETBACKS F 2Sr' S 20.'JC It,'. fy'
%XN ALLOWABLE BUFDNG HEIGHT
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4.e QE/OOLIINflJ 94¢ Se
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ALN4 TO ,.00R AREA MTV 29 %
r•. TAK: S WE BY
:ATES SE CE BY
AI'KTA9Y SEWER DSTWCT
REPHONE ECIWY.E BY
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LOT UNE STAKES MUST SITE PLAN
8E IN PUKE AT TIME OF ..•.•e %tiBo w.rr...w. 0000"'�'�
PoUNDATION INSPECTION
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WING HEIGHT CALCULATION aw^a•vu_fi BP BEJ Lmes — si -
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APPROVED'BY
1
0 m
32.E
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall .......................
Pier/Porch................
Retaining Wall............
Slab Insulation ............
PLUMBING:
4
Underground .............
Rough -In ......... I....... R
Commerclal Final ........
HEATING:
1�
GasTest .................
Gas Piping ................
Equipment ................ ..
Commercial Final.........
r
EXTERIOR SHEATHING
NAILING .................... q
FRAMING .................. �,;�'T • /Tim
INSULATION: -
Floorinsulation ..........
Wall Insulation ...........
Ceiling Insulation......... ,-
SHEETROCK NAILING ......
SPECIAL INSPECTION...... -
k
RADON MONITOR AT SITE.
FINAL APPROVAL
FOROCCUPANCY......
..
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