960647.pdfm
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CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION oe
OWNER NAVE NAME OF BUSINESS AODP
T?�
S I ATELICENSE NUMRER EXPIRATION DATE
Legal Description of Property - include all easements
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Parcel No.
Ea
NEW
RESIDENTIAL
IJ PLUMBINGINIECH
COMPLIANC OR
ADDITION
COMMERCIAL
CHANGE OF USE
APT BLDG.
El
REMODEL
SIGN
oREPAIR
❑ GRADING CYDS ❑ PENCE K-F1
El SWIM POOL
DEMOLISH
INSERT MOT
HO TUB SPA
GARAGE CARPORT
G WAIL/ RENEWAL
ROCKERY
NUMDCR NUMBER OF CRITICAL
OF DWELLING % AREAS
STORIES I UNITS • NUMBER
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
PERMIT
NUMBER 9606 7
LEGAL DESCRIPTION CHECK SUBDIwSON NO
LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REOUIREO OEDICATION
PROPOSED
TESCP Approved ❑
RW Permd Required ❑
Sir_, Ufe Perm,t Read ❑
InfpeCllOn Required ❑
Srdewll4 Requ,retl ❑
METER SIZE
I LINE SIZE
I NO OF FIXTURES
I PRV REOUIRED
YES ❑ NO ❑
REMARKS
ENGINEERING MEMO DATED REVIEWEDAY
FIRE MEMO DATED REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
f
SEPA REVIEW
COMPLETE JEXEMIT
E%P
ADD NO
SHORELINE +
VARIANCE OR CU
PUNNING REVIEW
BY DATE
SETBACKS — FEET HEIGHT
FRONT SIDE REAR
LOT COVERAGE
REMARKS
CHECKED BY TYPE OF CONSTRUCT( N CODE
>
OCCUPANT
GROUPC.3
SPECIAL INSPECTOR
REOUIRED 11 YES
AREA
OCCUPANT
LOAD
MARKS
PROGRESS INSPEt7' 'ONS PER UBC 108
FINAL INSPECTION REQUIRED
vawAnun
PLAN CHECK FEE
BUILDING
AISOURCEZINGD/DPLUMBING
FP
lan Check NO.
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
Pem11t Application: 180 Days
Permlt LITRIF. 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
successors In interest, agrees to indemnify, defend and hold
W harmless the Clty 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
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
z nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
C.
pro Vision."
I hereby acknowledge 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. I agree to comply with city and
THIS PERMIT
This application is not a permit until
state laws regulating construction; and in doing the work authoriz•
AUTHORIZES
THE
ONLY THE
signed by the Building Official or his/her
ed thereby, no person will be employed in violation of the Labor
Code of the State of Washington relating to Workmen's Compensa•
wORK
Deputy; and fees are paid, and receipt is
tion Insurance and RCW 18.27.
INSPECTION
acknowledged in space provided.
S,GNATURE (OWNER OR AGENT( DATE SIGNED
DEPARTMENT
q
CITY OF
EDMONDS
OFFIC N TURE DATE
/- ' 17 J
CALL FOR
RELEASED BY DATE
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-0220
ORIGINAL — File YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK — Owner GOLD — Assessor
IDbal
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LIE
Cam
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co
0
�t y at,
T0: Permit Coordinator, Building Division
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FROM: 6 FIRE DEPARTMENT
ENGINEERING DIVISION
PLANNING DIVISION
OWNER��j ADDRESS
PERMIT# 9 6 6 ADB# INSPECTED ON %/z y1Q
A field inspection was conducted to determine compliance with approved plans.
Final approval denotes there are no objections to the granting of:
Occupancy for the building Performance Bonds may be released
Maintenance Bonds may be released Landscaping is approved
,(Other inspected uPtOT 06rC04,1n4rS5,t(.—,1v-C.
$ZZ
PASSED FIRST INSPECTION - CONDITIONS NOTED
-PJvD
+
z �
FAILED INSPECTION - OUTSTANDING REQUIREMENTS - RECALL FOR INSPECIT�ON
1.
2.
3.
4
OCCUPANCY APPROVAL DATE %�Z`� gy
e ;:�!•
dk t
FAILED FIRST INSPECTION DATE BY
RE -INSPECTED - APPROVED
RE -INSPECTED - FAILED
RE -INSPECTED APPROVED
OCCAPRVL/TXTRECEP/October 13, 1993
DATE BY
DATE BY
DATE
FEES
RECEIPT#
:0M
0 _.
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...................
,.
FOUNDATION:
-
Fooling ....................
Wall.......................
Pier/Porch................
- Retaining Wall............
_..
_ ..
Slabinsulation............
-
:-
PLUMBING:
-
- -
Underground .............
`.
Rough -in ....... I.........
Commercial Final ........
HEATING:
-
-
Gas Test .................
Gas Piping ................
Equipment ................
-Commercial Final.; .......
..
EXTERIOR SHEATHING. ,
!•
NAILING ......................
FRAMING ......................
,...•. `..-.
' INSULATION:
Floorinsulation...........
- -•
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
RADON MONITOR AT SITE,
FINAL APPROVAL
p��Y
'7 -576
—ZV
FOR OCCUPANCY..........
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