970745.pdfO
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
0%VNl NAML NAME (?IBUSINESS
kI\re l7. M 0nt-I I
CITY ZIH TELEPHUNr HUe—
STATE LICENSE NUMBER L)"✓EXPIRATION DATE
n11}TU5µSI`I].N0 �. Lf -17
L Final naccrintion Of PrnnBIty - include all easements
reel No. 1-13�ib QL%3 C!li D.e1.UZ
NEW RESIDENTIAL Ut PLUMBINGRdECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT BLDG. SIGN
GRADING FENCE
REPAIR CYOS. I_x—F
DEMOLISH ❑I WNOSOOSTOVE SWIM POOL
NSERT MOT TUB/SPA
GARAGE CARPORT IF RETAINING WALL/ ROOKERY ❑ RENEWAL
NUMBER INUMBER OF
OF 1 DWELLING
WORK
US r PERMIT ry
ZONE �V %4�
NUMBER
JOB
ADDRESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REQUIRED DEDICATION
PROPOSED
TESCP Approved ❑
RW Pe— Reclined ❑
Street Uee Pelmn Ron it Inspection
Inspection Reci—ed ❑
Sldewslk ReRVeed ❑
METER SIZE
LINE SIZE
NO. OF FIXTURES
PEW REQUIRED
YES ❑ NO ❑
REMARKS
ENGINEERING MEMO DATED REVIEWED BY
FIRE MEMO DATED - REVIEWED BY
SIGN AREA
ALLOWED PROPOSED
SEPA REVI EW
COMPLETE EXEMPT
E%P
ADS NO.
SHORELINE IF
VARIANCE OR CU
PLANNING REVIEW BY
DATE
SETBACKS — FEET
FRONT SIDE REAR
I HEIGHT
LOT COVERAGE
REMARKS
CHECKED BY TYPE �)OLLF..jj CONSTRUCTION CODEQ'
//l 6CiN
L
/ `T
OCCU NT
GRO
SPECIAL INSPECTOR
REQUIRED
❑ YES
AREA
OCCUPANT
LOAD
R MARKS
PROGRESS INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
PLAN CHECK FEE I n `L
HEAT SOURCE.
GLAZING
-A S
PLUMBING
r.
Plait Check NO.
MECHANICAL
✓
v
This Permit covers work to be done on private properly ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sldewPlks,
driveways, marquees, etc.) will require Separate permission.
STATE SURCHARGE
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
EKG. INSPECTION FEE
successors in interest, agrees to indemnify, defend and hold
W harmless the City of Edmonds. Washington, its officials,
i 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 be deemed to
PLAN CHECK DEPOSIT
omodily, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
provision."
1 hereby acknowledge that I have read this applic illon; that the
APPLICATION APPROVAL
information given is correct; and that I am the owner, or the duly
ATTENTION
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
state laws regulating construction; and in doing the work authoriz.
AUTHORIZES
This application is not a permit until
Ed thareb person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
,-no
Code oft a State of Washington relating to Workmen's Compensa.
WORK NOTED
Deputy; and fees are paid, and receipt is
Lion Ins ante and RCW 1827.
INSPECTIONacknowledged
in space provided.
SIGNAiUP ,IOWNEq OR AGENT DATE SIGNED
DEPARTMENT
—7
17-
CITY OF
OFF, L SIGNATURE DATE
—
EDMONOS
9
CALL FOR
RELEASED BY DA
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
771-ORIGINAL — File YELLOW — Inspector
02�0
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
SECTION 109
PINK — Owner GOLD — Assessor
1
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
- SETBACKS ..................: t.
FOUNDATION:
- - -
.Footing . ................
-
Well. :....
-„ ....::.:... ..:,.:, Pier/Porch.....::.:....:... ,._.
... ... Retaining Wall..::.......:
•- Siabinsulation............ ,
- PLUMBING: -.
•__, .;... ,.. _Underground .............
..
�. .. :.. .. .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 APPROVALS
FOROCCUPANCY......... �---r
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_