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CITY OF EDMONDS
USE ZONE PERMIT
T S ' N/UMBER
CONSTRUCTION PERMIT APPLICATION
ADDRESS
06 AC/
OIVHER NAME NAILE OF BUS)
LEGAL DESCRIPTION CHECK
'UBCD^•IiVISION NO
LID NO
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REOUIRED DEDICATION—
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TELEPHONE NUMBER
PROPOSED _may__
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ME/TE,RI SIZE
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LINE SIZE
NO OF FIXTURES
PRV REOUIRED
YES D NO ❑
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ADDRESS
REMARKS
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ENGINE zGM90 DATED REVIEWED Y
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FIRE MEM DATED REVIEWED BY
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STATE LICENSE NUMBER /)% EXPIRATIONnAT�E
VARIANCE OR CU
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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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LOT COVERAGE
REOUIRED SETBACKS (FT.)
PROPOSED SETBACKS(FT.)
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DATE
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REMARKS
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COMPIL ANCE OR
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ADDITION COMMERCIAL CHANGE OF USE
REMODEL APT SLOG. SIGN
CHECKED BY TYPE OF C; BTRUCTION COO��
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OCCUPANT
REMARKS
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PROGRESS INSPECTIONS PER UBC 108
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ITYPE OF USE. B INESS//�R ACTIVITY) EXPLAIN,.
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DESCRIBE RKTO e/�DONE (ATTAy`" PLOT ANI
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FINAL INSPECTION REOUIRED
VALUATION
FEE
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PUN CHECK FEE
BUILDING
HEAT SOURCE
GLAZING
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PLUMBING
Plan Check No. "/IF - \ •�
MECHANICAL
This Permit covers work to be done on private properly ONLY.
GRADINGIFILL
And 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
ENG. INSPECTION FEE
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successors in interest, agrees to indemnify, defend and hold
harmless The City Of Edmonds, Washington, its officials,
employees, antl agents from any and all claims for damages of
PLAN CHECK DEPOSIT
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whatever nature, arising directly or indirectly from the issuance
of this permit. Issuance of this permit shall not be deemed to
waive or reduce any requirement of any city ordinance
nor limit in any way the City Is ability to enforce any ordinance
proviSiOn.-
TOTAL AMOUNT DUE
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1 hereby acknowledge that I have read this application; that the
information given is correct; and that I am the owner, or the duly ATTENTION APPLICATION APPROVAL
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 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 State of Wash in on(elating to Workmen's Compensa. WORK NOTED Deputy; and fees are paid, and receipt is
tion nsurzmce ario RCW 18. \ "FECT)ON acknowledged in space provided.
SIG UNE i01'NER OR AG � DATE SI `LED DEPARTMENT
OFF CIA ' SIGNATURE pPTE
CITY OF
EDMONDS
CALL FOR E /-(�/ DATE
q NTION INSPECTION (.' 1
IT 1 UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE y //��//��
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR 77 1 - U2F0 O GINAL - FIB YELLOW - Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC �r
SECTION 109 lql- 7 L PINK - O•A'r,er GOLD - Assessor
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RECORD OF INSPECTIONS •
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing....................
Well....................... - - --..
Pier/Porch................
Retaining Wall............
Slabinsulation.............
PLUMBING:
Underground .............
Rough -In .................
Commercial Final ........
HEATING:
Gas Test .................
Gas Piping ................
Equipment ................
Commercial Final.........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION:
Floor Insulation...........
Well Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION ......
MISCELLANEOUS
FINAL APPROVAL —a
FOROCCUPANCY..........
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