960562.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
I Sl'NI n Y•LiI NA\II. Tc OLISINES `S I
d
A]
PERMIT
NUMBER 9r,0562.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appipvee D
RW P` RegI.."d D
REQUIRED DEDICATION -__-
EIl I Use Pe Read D
EXISTING __-----
PROPOSED _-------- '-"
Infpeclipn Requiiee Q
SldewXlk Requued
512E
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
METER
YES ❑ NO 0
BY
AtELICENSENUMBEII SIGN AREA' --
ALLOWED PROPOSED COMPLETE EXEMPT
gal Description of Prope y -include all easements
SHORELINE
EXP
Y DATE
VARIANCE OR CU PLANNING REVIEW B
c)
SETBACKS -FEET HEIGHT LOT COVERAGE i
Z
FRONT SiDE REAR g
'rapeny REMARKS
aX ADDDunt 7in
arch No.
NEW .Er RESIDENTIAL PLUMBINGeaECHE] COMPLIANCE OR
-
El4ODITION ElCOMMERCIALOF USE COMMERCIAL '
O NEMOOEL APT SLOG. SIGN
jr�j CHECKED BY TYPE OF CONSTRUCTION CODE GROUPANT
+Z
I� BEINIT ❑ GRADING ❑ FENCE x-� � 9 �J
LYDS. OCCUPANT
WOODSTOVE SWIt
POOL SPECIAL REQUIRED SPECTOR AREA LOAD
DEMOLISH O INSERT ❑ YES
GARAGE RETAINING WALL/ REMARKS O
CARPORT � RENEWAL
ROCKERY PROGRESS INSPECTIONS PER UBC 108 c
(TYPE OF USE, BUSINESSORACTI ITY)E%PLA N: C�
AREAS
NUMBER NU CRITICAL
Or DWELLING INUM ER
STORIES UNITS
DESCRIBEWOnKTOBED NE (ATTACH PLOT PLAN) /I FINAL INSPECTION REQUIRED
R VALUATION FEE
PLAN CHECK FEE 1
BUILDING v
SOURCE
GLAZING
%
7HEAT
A
PLUMBING
MECHANICAL
Plan Check No.
This Permit covers work to be done on private property ONLY.
domain (curls, sidewalks,
GRADINGiFILL
Any cons ruClion on the public
driveways, marquees, etc.) will require Separate permission.
STATE SURCHARGE
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 year' Provided Work is Started Within 180 DOYS
her spouse, heirs, assigns and
ENO, INSPECTION FEE
•'Applicant. on behalf of his or
successors In interest, agrees to indemnify.
ofnd ficialls,
ahington,1ets
W harmless the City of Edmonds,for damages 0
(p
dl directly Orn nd Ulect Ym from the issuance
a EmployWhatever nalUre arising no nts from
shall not deemed to
pLAN CHECK DEPOBIT
0 of this permit. issuance of this permit
it
modify. waive or reduce any requirement of any city ordinance
to enforce any ordinance
TOTAL AMOUNT DUE
nor limit in any way the City's ability
provision."
that I have read this application; that the
ATTENTION
APPLICATION APPROVAL
I hereby acknowledge
information given is correct; and that I am the owner, or the duly
I egnetlen GO with
AUTHOR
This application is not a permit until
his/her
authorized agent of the owner. horfz•
state laws r ulatin$.constru doing the work aut
in violation of the Labor
ZES
ONLY THE
NOTED
signed by the Building Official or
are id. and
n aprovided.ceipt is
etl thereby, no son _ .e pl yed
. - rela ing 10 Workmen's Compensa•
WORK
acknowledged sp-a
Code of the S to of gt
lion 1SU ran a an C 18.2
SIGNATURE .0i'NE R ENi
TE SIGNED ,.,,
j//
INSPECTION
DEPARTMENT
OF
DATE
OFFICI S S NAT RE ACITY
Y-
EDMONDS
�� U
PATE
CALL FOR
RELEASED DY
ATTENTION
INSPECTION
BUILDRE /�
if IS UNLAWFUA MADE IAND APPROVALNG OR UOR 771-0220
ORIGINAL - File YELLOW - inspector
UNTIL FINAL INSPECTION NAS BEEN
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
PINK - Owner GOLD - Assessor
SECTION 109
-. IDz eT
3 2
a
O
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall....................... ;
Pier/Porch................
Retaining Wall............
Slab Insulation............
PLUMBING:
Underground .............
Rough -In ................. - f
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 — - 9.
FOR OCCUPANCY.......... �'-�'� l�
32XIC