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CITY OF EDMONLIS
USE
CONSTRUCTION PERMIT APPLICATION ZONE PERMIT 7J
NUMBEp /
QWi{ER NgAIE N4ME OF BUSINESS
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SOB .3153
ADDRESS
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APT a
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TELEPHONE NUMBER
HT OF WAY P
PUBLIC RIGPER OFFICIAL STREET MAP TE5CP ADNoved
EXISTING RW
❑
NAME
---- REOUIRED DEDICATION. POlmn RPquued
_ SIIOOI U.-Perm"Rega
PROPOSED
❑
❑
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InfPOCII0, Requ„w
Sidewalk Requ,,Vo
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❑
w ADDRESS
METE" 512E LINE 512E NO OF FIXTURES PRY REOUIRED
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REM jUKS YES D
NO ❑ZIP
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TELEPHONE NUMBER
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NAME
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ADDRESS
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ENGINEERING MEMO DATED
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ZIP
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TELEPHONE NUMBER
REVIEWED RY
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' STA10
TE LICENSE NUMBER
fIRE MEMO DATED
EXPIRATION DATE
REVIEWED BY
Legal Description ! '
SIGN AREA
of Property -include all easements
O
SEPA REVIEW
ALLOWED PROPOSED COMPLETE ADS NO
EXEMPT
iE
SHORELINE E
O
E%P
VARIANCE OR CU PLANNING REVIEW BY
DATE
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Proped
T..rch AccounI "• J'L r _ _
PaI }ir��+{"i
SETBACKS — FEET
HEIGHT LOT COVERAGE
FRONT SIDE REAR
i
No. { { -
REMARKS
i
NEW Y, RESIDENTIAL PLUMBINGIMECH
ADDITION COMMERCIAL ❑ COMPLIANCE OR7•Vr7ry
CHANGE OF USE
REMODEL APT, BLDG,
SIGN
ElGRADING
REPAIR cros FENCE
CHECKED BY TYPE OF CONSTRUCTION CODE
OCCUPANT
DEMOLISH a WOODSTOVE
INSERT SW POOL POOL
{
- {r%- l�% '
SPECIAL -AREA�,,{
.�' GROUP
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HOTTUSISPA
GARAGE ❑ RETAINING WALL/ \I"'1i
CANPORT ROCKERY
INSECTOR
REOUIRED OCCUPANT•
�'L/ YES
_
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Y'-.'i. '1
= RENEWAL
(TYPEOF USE. eusINESStee`!.OR CTWITq EXPLAIN.
LOAD
REMARKS
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NUMBER •
PROGRESS NSPECTIONS�ER UBC 108
i
NU ER OF
OF DWELLING CRITICAL
Wo STORIES AREAS
i (.•� / T E,/ 3•�r.r-(/�`�
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UNITS NUMBER
DESCRIBE
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�,CL�ti. Y` • �1f .I .: 'vgry ��
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WORK To BE OONP 1$T3ACH:P.I@T-P.LTINL v C 1+•F..
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FINAL INSPECTION REQUIRED
PLAN CHECK FEE
VA:UATION FEE
HEAT SOURCE'
GLAZING
eU1LDING
f�1
Plan Check No.
PLUMBING
This Permit covers work to be done
MECHANICAL
on private property ONLY.
Any construction on the public domain (curbs, sidewPlks,
driveways,
GRADING/FILL
marquees, etc.) will require separate permission.
Permit Application: ISO way
STATE SURCHARGE
Permit Limit: 1 Year- Provided Work is Started Within 180 Deys
"Applicant,
AN" ORM"G€T'
On be1l�fTof 15 Or.(11 spouse, heirs, assigns
successors
and
in interestq agrees to iptleinnify, defend and
W harmless
FTN ..INSPECTION FEE
hold
the City of Edmonds, Washington, its officials,
employees, and agents from
_
I ~
any and all claims for damages of
i whatever nature, arising directly or indirectly from the Issuance
of this permit. Issuance
`
D of this permit shall not be deemed to
o modify, waive or reduce any requirement of any city ordinance
z nor omit in any way the City's
PLAN CHECK DEPOSIT
ability to enforce any ordinance
Provision."
I hereby acknowledge Thal I have
TOTAL AMOUNT DUE
read this application; that the
information given is correct; and that I am the owner,
,. `,..4
or the duly
authorized agent of the owner. I agree to comply with city and
state laws regulating construction; an
ATTENTION
APPLICATION Pp
APPROVAL
aIT to tloing the work its
etl (hereby, no person will be employed in violation of the Labor
Code of the State of Washington
IT
TAUTHORIHIS PERMES
ONLY THE
THE
This application 1S not a Permit until
relating to Workmen's Compensa•
lion Insurance and RCW 18.27.
SIGN4rURE
WORK
signed by the BuiltlIng Official or his/her
.Deputy; and fees are
10"YNER OR AGENiI
SIGNED
'
INSPECTION
DEPARTMENT
paid, and receipt is
, e,kn?wledged in space provided.
-"� •y1^..:._., _ - -2 ') ..
CITY OF
EDMONDS
OFFICIAL• SIGNATURE '
'ji. DATE;(
ATTENTION
i;i : I ,A 14
T IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
VTIL A FINAL INSPECTION HAS
CALL FOR
INSPECT ION
RELEASED OY - - - DATE
/
ER BEEN MADE AND APPROVAL OR
CERTIFCATE OF OCCUPANCY HAS BEEN GRANTED.
%%
• • 1 —0220
ORIGINAL
UBC
— F,le YELLOW — Inspector
•^ "' �`'r�
PINK —Owner GOLD — Assessor
\ 0 ...._-.. _.
32 X (;'�
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RECORD OF INSPECTIONS
INSPECTOR DATEAPPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Wall ....................... ._----�—
Pler/Porch................ --
Retaining Wall ............
Slab Insulation............
PLUMBING: --------
Underground .............
Rough -in .................
Commercial Final .... . • •
HEATING:
_•_—��
a
Gas Test .................
—_�
Gas Piping ..............
. r
Equipment................
--------�—+y�
Commercial Final.........
EXTERIOR SHEATHING
-- '—
{'
NAILING ....................
—� S
FRAMING .............
INSULATION:
-------�'
Floor Insulation...........
--�
Wall Insulation .........
— —
Ceiling Insulation ...
SHEETROCKNAILING .....
------
SPECIAL INSPECTION . . . . . •
------
FINAL APPROVAL
FOR OCCUPANCY ..........
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.,6440
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