970732.pdf11
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USE PERMIT
CITY OF EDMONDS ZONE T NUMBER .970732\
CONSTRUCTION PERMIT APPLICATION cos sunEnPT,
OWNER NaMF. NAME OF BUSINESS
ADDRESS
NUMBER
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/11.11H n �agc�t
T Tc
Property
Account
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A..
Parcel
CJ
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ONE'.Y
RESIDENTI L
PLU.E1l. AEC.
�ADOITION
COMMERCIAL
CHANGE OF USE
ElREMODEL
APT BLDG.
SIGN
❑ GRADING
❑
ElREPAIR
CYD
FENCE X—F
r7DEMO1-IS11
❑ NSERT TOVE
❑
SWIM
HOT TUB/SPA
AGEG
WALL/
CARPORT
ROCKERVA
❑
RENEWAL
TYPE OF USE.
N S OR ACTIVITY) E%PLA N.
NUMBER
F4UMBEA OF
CRITICAL
OF I.WELLING
STORIES -.
IINITS
AREAS
NUMBER
LEGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING ..__ REQUIRED DEDICATION __
PROPOSED
TESCP Apprered ❑
RW Pa —I Requlled ❑
Slreel U,q Permd Reed ❑
Infpecllgn Raq VlreO ❑
S,dawalk Requlled ❑
METER SIZE
LINE 512E
NO OF FIXTURES
PRV REOUIREO
YES D NO ❑
REMARKS
ENGINEERING. MEMO DATED REVIEWED BY
FIRE MEMO DATED REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
SEPA REVIEW
COMPLETE EXEMPT
EXP
ADB NO.
SHORELINE A
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET HEIGHT
FRONT SIDE REAR
LOT COVERAGE
REMARKS
.NECKED BY
TYPE,OF,QONSTRUCTION CODE
CC
GCCOUPANy
SPECIAL INSPECTOR
REQUIRED ❑ YES
AREA
-
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
L
_ -
VALUATION
"
PLAN CHECK FEE
BUILDING'���
HEAT SOURCE
GLAZING
B!D
PLUMBING
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Plan Check No.
MECHANICAL
i
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sldewPlks,
'a
STATE SURCHARGE
driveways, marquees, etc.) will require separate permission.
Permit Application: 180 Days
Permit Limit: 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
,A successors in interest, agrees to indemnify, defend and hold
W harmless The City of Edmonds, Washington, its officials,
f employees, and agents from any and all claims for damages of
Y
whatever nature, arising directly or indirectly from the issuance
`f
x of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
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omodify, waive or reduce any requirement of any city ordinance
TOTAL AMOUNT DUE
z nor limit in any way the City's ability to enforce any ordinance
provision."
C/
APPLICATION APPROVAL
a
hereby acknowledge that I have read this application; that the ATTENTION
Information given is correct; and that 1 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
it
stale laws regulating co ruction; In doing the work authoriz•
AurrloRlzss
THE
signed by the Building Official or his/her
ed thereby, no pers will a to ed in violation of the Labor
Code of the State Washi elat ng to Workmen's Compensa•
ONLY
wOAK NOTED
Deputy; and fees are paid. and receipt is
tion Insurance d RC
INSPECTION
acknowledged in space provided.
SIGNATURE IOW R OR T TE �IGNED
UUCITY
DEPARTMENT
OF
OFF! IGNATURE D TE
EDMONDS
CALL FOR
RELEASED BY .ATE
ATTEN N
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
�
INSPECTION HAS BEEN MADE AND APPROVAL OR 771
ORIGINAL File YELLOW — Inspector
1
UNTIL A FINAL _OLE
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
—
SECTION 109
107b7
PINK — Owner GOLD — Assessor
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RECORD OF INSPECTIONS
INSPECTOR - DATE APPROVED -
SETBACKS ...................
FOUNDATION: - - - -- -
Footing ................
...
Wall..:. .....I....... r
....-..,.
�.., 'Pler/Porch................ ..
Z
Retalning WaIL...........
rw
Slabinsulatlon ........... .-.
_
cc
Q
PLUMBING:
wU
.,
.. -
Underground .............
w'Rough-In
..................'.
_jr
u_":
_ ;.. Commercial Final-........
}to
0.
Lu
HEATING:
LL
Gas Test ................. -
- Gas Piping ................. ..
Z.
_
Z_F—
.....-
_.. - Equipment ........ ::.......
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Z F- -
.... Commercial Final......... :
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-
-
j,
_ EXTERIOR SHEATHING - - -
U tn} ' -
NAILING.. ..................
w wij
FRAMING' ................
`'
F-
F'01
INSULATION:
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Floorinsulation........... -
OH
Wall Insulation ....
Z y�
-
Ceiling Insulation...... ..
SHEETROCKNAILING ......'
1
SPECIAL INSPECTION ......
1
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.. RADONMONITORATSITE. -
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FINAL APPROVAL
0 j
FOR OCCUPANCY.......... L( !!
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