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CITY OF EDMONDS
usE PERMIT
ZONE r20 NUMBER 97044/4-
CONSTRUCTION PERMIT APPLICATION
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ADDRESS i5/ �J �/�%•UITEAP
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OWN NAMEINAM OFB SINESS
U/O/v S
LEGAL L..CRIPTION/CHECK SUBDIVISION
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LID NO
21 U
M LING ADO(R/�E�SE9
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REQUIRED DEDICATION—_
TESCP App—ed ❑
RW Pe —I Req-ed ❑
Sueel Ure Perm, I FIM d ❑
Clir ZIP
T ELEPHONE NUMBER
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PROPOSED
InIP.11 nReyo,red ❑
Sidewalk Req-ed ❑
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NAME
METERSIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
YES D NO ❑
ADDRESS
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REMARKS
CITY ZIP
TELEPHONE NUMBER
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NAME
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ADDRESS
ENGINEERING MEMO DATED gEVI.EO BY
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CITY ZIP
TELEPHONE NUMBER
;IRE MEMO DATED REVIEWED BY
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1.�SEMBER�
EXPIRATIO D
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STATE LICP
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VARIANCE OR CU
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SHORELINE e
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Legal Description of Property - include all easements
SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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EX I
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT UP SIDE REAR O
W
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Propedy
Tarel No. S/31-OU�-Gb2-"r)O&
Parch No.
LOT AREA
PUNNING REVIEW BY
DA TE i
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NEW v rl RESIDENTIAL O PLUMBINCJMECH
COMPLIANCE Ofl
ElADDITIONElCOMMERCIALCHANGE OF USE
ElREMODEL APT. BLDG. SIGN
GRADING FENCE
REPAIR CYDS O I—x_FT)
REMARKS
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/�V `+IN� /�i ��� 'S d
CHECKED BY
TYPE Of CONSTRUCTION COOKOCCUPANT
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DEMOLISH POOL
INSERT TOVE HOT TUBBPA/ y
CARPORT ROCKERVGARAGE 7-1 G WALL/ ® E OZ6 /
EEE
(TYPE OFUSE,,1USINESSORACTIVITY)EXPLAIN:
SF iCCS
SPECIAL
gEDU REO [INSPECTOR
YES
AREA
OCCUPANT
REMARKS u
PROGRESS INSPECTIONS PER UBC 108 c
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS [,•�`_/7/
NUMBER .J
DESCRIBE WORK TO BE DONE (ATTACH PLOT PLAN)
FINAL INSPECTION REQUIRED
/�1/ j1 /YJA/I�il a
VALUATION
FEE
PUN CHECK FEE
BUILDING
HEAT SOURCE:
GLAZING
D/D
PLUMBING
Plan Check NO.
MECHANICAL
This Permit covers work to be done on private properly ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sldev iks,
driveways, marquees, etc.) will require Separate permisslon,
STATE SURCHARGE
Permit Application: 180 Days
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
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"Applicant, on behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
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
of this permit. Issuance of this permit shall not 6e tleemed to
modify, waive or reduce any requirement of any city ordlnan Ce
nor limit in any way the City's ability to enforce any ordinance
provision."
ENO. INSPECTION FEE
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PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I hereby acknowledge that I have read this application; that the ATTENTION
Information given Is correct; and that I am the Owner, or the duty
authorized agent of the owner. I agree to comply with city and THIS PERMIT
stale laws regulating construction; and In doing the work authoriz• AuTHORIZEs
ed thereby, no person will be employed In violation of the Labor ONLY THE
Code of the State of Washington relating to Workman's Compensa• WORK NOTED
Lion Insurance ana RCW 18.27, INSPECTION
APPLICATION APPROVAL
This application Is not a permit until
signed by the Building Official or his/her
Deputy; and fees are paid, and receipt is
acknowledged in space provided.
SIG RE (OWNER OR AGENT( DATE SIGNEAr-D DEPARTMENT
CITY OF
OFF( l' el NATURE DATE
A
CALL FOR
ATTENTION INSPECTION
LEASED . DATE
---"--"—^—__
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� -OZ2O
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL DR
ORIGINAL - Flle YELLOW - Inspector
n C—... ;.—. yr .....--• ---
SECTION 108 PINK - Owner GOLD - Assessor
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RECORD OF INSPECTIONS
----
INEPEOTOR DATL APPROVED
-.....
SETBACKS ................... -- -
FOUNDATION:
.. - ,.,..
Footing .... .... ........ �•„
Wall,,,,,,,,,,,,,,,,,,,,,,,
Plar/Porch,,,,,,,,,,,,,,,,
4Yy.
RelalningWell.....��,..,,
Slabineulatlon..........
PLUMBING:
Underground ...... --
. ---...
Rough -in .......•.,,....., -
-
Commercial Elnal ........ - —
"
HEATING;
O e a Teel .................
� -
...
Equipment .............��.
Commerclal FIneL ........
EXTERIOR SHEATHING
NAILING ...........•....•.•.
FRAMING ................
INSULATION:
Floor Insulation..........,
Well Insulation ..........Calling
Insulatiom.
'" �' ` • t
SHEETROCK NAILING ......
•���
SPECIAL INSPECTION ......
it
MISCELLANEOUS
t...
FINAL APPROVAL•47
FOR OCCUPANCY........ i—�
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Foie e0^110terc geCd2,D
RECORD
OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
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FOUNDATION:
h'vvung....................
F3Y dT .S
Wnll,.....,•............ "c
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PIat/Porch..... ...1.......
natalning Wall...,.,......
Slab I noulation............
PLUMBING:
Underground .............
• I
Commercial Final........
i
HEATING:
Gas Test.................5
�n �2rT' •i"`O
Gas Piping .................
.` .. Equipment ..............
Commercial Final..........
EXTERIOR SHEATHING
NAILING ....................
-' FRAMING ....................
® q.
�� •� INSULATION:
Floor Insulation..........
•• Wall Insulation .........� —
q 4�
Z • Z �• f
Calling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION......
- -
' RADON MONITOR AT SITE
FINAL APPROVAL
FOROROCCOCCUPANCY.......... -----�
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