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CITY OF EDMONDS =oNE PERMITNUMBER / -9701_9
CONSTRUCTION PERMIT APPLICATION
JOB iy
OWNER NAME NAME OF BUSINESS ADDRESS C-'O / W41
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jyl/J [��'/C'f= y'(�� �J )/ LEGAL DESCRIPTION .-L"I SUBDIVISION N LID NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved ❑
RW Pt Requ,f ❑
EXISTING REQUIRED DEDICATION
FI
Street Ufe Perm,l Req'tl
U1.
N
PROPOSED
lo,pechon Repu,reC ❑
S,dewsl%RepuReO ❑
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES D NO ❑
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ADDRESS
CITY ZIP TELEPHONE NUMBER
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STATE LICENSE NUMBER EXPIRATION GATE
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allo.
NEW
LJ RESIDENTIAL
PLUMBINGIMECH
ADDITION
COMMERCIAL
CHANGE OF USE
REMODEL
APT_ BLDG.
SIGN
❑GRADING
❑ FENCE
REPAIR
CvpS
(_%_Fit
DEMOLISH
WOOOS
POOL
INSERT
HOT
HOT TUB/SPA
GARAGE
CARPORT
II ROCKERYG WALL/
❑ RENEWAL
RIANCE OR CU
AGE! a
SHORELINE e
SERA REVIEW
SIGN
AREA
HEIGHT
LETE EXEMPT
LALLOWED
ALLOWED
PROPOSED
ALLOWED PROPOSED
T COVERAGE
REQUIRED SETBACKS(FT.)
PROPOSED SETBACKS(FT.)
IPR.POSED
FRONT SIDE
PEAR
FRONT L/R SIDE REAR
�......... ❑ YES ..,,
EMARKS
PROGRESS INSPECTIONS PER UBC 108 O 0
r
A % A N
NUMBER
IN
... En OF
CRITICAL
/ / ` NJ /o K E
G OF
mo STORIES
DWELLING /
UNITS
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
(ATTACH PLOT PLAN)
--/
/
P� !/OcE �ECTC/G FGG�!/�9CG
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
t�O G�J LOCe SST
HEAT SOURCE:
GLAZING
BUILDING
p/D
PLUMBING
Plan 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
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
successors in interest, agrees to indemnify, defend and hold
w harmless the City of Edmonds, Washington, its officials,
semployees, 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
modify, 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."
I hereby acknowledge that I have read this application; that the
information given is correct; and that 1 am the owner, or the duly
ATTENTION
APPLICATION APPROVAL
authorized agent of the owner. I agree to comply with city and
THIS PERMIT
slate laws regulating construction; and in doing the work authoriz•
AUTHORIZES
This application is not a permit until
ed thereby, no person will be employed in violation of the Labor
ONLY THE
signed by the Building Official or his/her
Code of the Slate of Washington relating to Workmen's Compensa•
WORK NOTED
Deputy; and fees are paid, and receipt is
tion Insurance aria RCW 18.27.
INSPECTION
acknowledged in space provided.
E IOW EP OR AGENTI / DATE SIGNED
DEPARTMENT
L
CITY OF
EDMONDS
OF L S SI NATURE , DATE
,L f'i1�I��V
CALL FOR
RELEASED B OAT
ATTENTION
INSPECTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
��� _0220 ORIGINAL —File YELLOW —Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED. UBC
SECTION 109
PINK —Owner GOLD — Assessor
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is
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[AIN
INSPECTOR I DATE APPROVED
SETBACKS ...................
FOUNDATION: -
- Footing .................... .,'..
Well....... ................
- Pler/Porch..............: _
•
, Retaining Wall.. .......... _ _ -:- -. _.. �_"' ,• ., ;..
-
. Slabinsuletlon...........
.._. ..PLUMBING: "-.. .._ .. :. .'.
- Underground... .......,.
- _.... Rough -in ........ ..�....... ,.
- .. .. .... CommercielFlnel....-..::
- HEATING: .. ..
GesTest................-
- - Gas Piping ..........
- - Equipment:...-. ....�:
Commercial Final..........'
EXTERIOR SHEATHING
NAILING .....::-..........-
- :.. FRAMING ..................
INSULATION:
•. -
_ Floorinsulatlon.... ...... .,. _ ,.:
Well Insulation............ ... ... .. :,, .. ...
._; Ceiling Insulation.........
SHEETROCK NAILING....:.
SPECIAL INSPECTION...... -
- MISCELLANEOUS
- -
FINAL APPROVAL
FOR OCCUPANCY......... (
-
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