960389.pdf.Iq I
usE PERMIT
CITY OF EDMONDS LONE NUMBER 96,6389
CONSTRUCTION PERMIT APPLICATION ,OU SUITE All
.,,':NI n NAVE `:Al,f. U' BUSINESS ADDRESS ' C, f
I;5tj4 M wl, VI IJcA�
T— 21P jI T�E LE PHONE MBER
ME
Ah S
>Dun[s:; ZZ /
IY 21P ELEPHONE NUMBER
i (l 1110n tiro L7s 4z r 1- 44
V4 IE
ADDnrss )
(Z3r." �,•5 6.k. ���'L
CITY ZIP TELEPHONE NUMBER
-1Al E II CENSE NUAIR[ SL-G_-X,_Ir C/V E%PIRATIONDATE
I —t nserintinn of PronertV - Include all easements
A Pa
NEW
� RESIDENTIAL
•(.C..T PLUMBING/MECH
�AD""ON
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
ElREMODEL
APT. BLDG.
SIGN
nEPAl F1
❑ GRADING OVGS.
❑ r FENCE x_I
DEMOLISH
WOODSTO E
INSERT
SWIM POOL
HOT TUB:SPA
CARPORT
ROCKERY- WALL/
❑ RENEWAL
(TYPE OF 11SE. BUSINESS
OR ACT( ITY) E%PLAIN.
NUI.If"n
Or
SI DRIES I
(NUMBER OF
DWELLING
UNITS
(CRITICAL
AREAS
NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLANT
IEGAl DESCRIPTION CHECK
SUBDI ISION NO
U NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING--REOUIREOOEDICANON-_---.
PROPOSED -
TESCP Approved ❑
RW ermd Red,pled ❑
st":1 USe Pc, —need ❑
IRSpeC11On Regll ed ❑
S,dIi Redu,red ❑
METER SIZE
LINE SIZE
NO OF FI%TITRES
PRv REOl11RED
YES ❑ NO ❑ V
REMARKS
z
ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE JEIEMIT
E%P
ADS NO
SHORELINE A
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET HEIGHT
PRONT - SIDE REAR
LOT COVERAGE
REMARKS
CHECKED BY
n
I TYPE OF CONSTRUCTION CODE
.7
GRCOUPANT
SPECIAL INSPECTOR
REQUIRED YES
AREA
L-ODA�PANT
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
•�O
VALUATION
FEE
V„ I - I.Y./ LrN u/
PLAN CHECK FEE
emcDlNc
I IEAT,OURCE:k /y'Ts^rF�CJ
,
GLAZING
%
�^
G/C/(+ - / -1 �1 c < V
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,
driveway$. marquees, etc.) Will require separate permission.
STATE SURCHARGE
Permit Application: 100 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work is Started Within 180 Days
Applicant. on behalf of his or her spouse, heirs, assigns and
ENG. INSPECTION FEE
successors in Interest, agrees to Indemnify, defend and hold
W
s
harmless the City of Edmonds, Washington, its officials,
employees, and agents from any and all claims for damages
of
—
<
Whatever nature, arising directly or indirectly from the issuance
PLAN CHECK DEPOSIT
T
of this permit. Issuance of this permit shall not be deemed
to
T
modify, waive or reduce any requirement of any city ordinance
nor IImN in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
(21 ^ Y3
provision."
I hereby acknowletlge that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. 1 agree to comply with city and
THIS PERMIT
This application is not a permit until
stale laws regulating construction: and in doing the work authoriz
ORIZ
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
THEE
woRK NOTED
Deputy: and lees are paid, and receipt is
Code of the State of Washing on relating to Workmen's Compensa•
acknowledged in space provided,
lion In a nce and RC 1
INSPECTION
DEPARTMENT
SIG. u E ,O,v ER OR EN DATE SIGry ED
+'
OFFICI S ATURFT DATE
70
s
G
EC
CALL FOR
RELEASED BY DATE
ATTENTIGI64
INSPECTION
IT 15 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� �0�60 ORIGINAL — F,le YELLOW — inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
SECTION 109
102 BY
PINK — Ov.cer GOLD —Assessor
O ... ...-. ....-.».� I'
�..
1. e
■,
(J
U
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall .......................
Pier/Porch................
Retaining Wall............
Slab Insulation............
PLUMBING:
underground..........�1���
9�
6
Rough -In .................,#�
-f- ---
Commercial Finai........
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
FOROCCUPANCY.........,
r
1. a
3201