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us E PERMIT 9f3�GIG
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOBl
ADDRESS �� I� C/I I' /ICJ (C.I•v I�.'1
OWNEII NAME NAME IF BUSINESS
LEGAL DESCRIPTION CHECK 3UBDIV15'ON N LID NO
MAILING ADDRESS � �Y
ro,ed
ReOun
5 O / PUBLIC RIGHT Oermd TESCP qp R,Q,. ❑
C 1// ,J F WAY PER OFFICIAL STREET MAP RW Pi ❑
C." 21P TELEPHONE NUMBER EXISTING REQUIRED DEOtCgtION Shall Use Permit Req d ❑
�' Inapecbin Ae led ❑
f/ O S C 6 () � 1- 4 r PROPOSED B,elwl;M Regwe'd ❑
NAME Ij ... -
METER 512E I LINE 512E I ND OF f1%TUBES PRV REQUIRED
YES ❑ NO ❑
STATE LICENSE NUMBER EXPIRATION DATE
L.ci .-., <<�S arc, I•I/F•c.< - Ip,
Iamel No.
NEW RESIDENTIAL PLUMBINGRAECH
ADDITION 0 COMMERCIAL
LHANGEOFUSE
54REAIO.EL APT. BLDG. SIGN
REPAIR ❑GRADING CYDS ❑ 1 FENCE X--FT)
SW DEMOLISH NSERTTOVE HOT POOL
TUS SPA
CARPORT ROCKERY WAIL/ ❑ RENEWAL
NUMBER a (NUMBER OF
DWELLING
PLAN)
EXP
EXEMPT I ALLOWED
❑ YES I
5INSPECTIONS PER UBC 108
FINAL INSPECTION REQUIRED
VAWATION I FEE
PLAN CHECK FEE ��
UR SIDE
HEAT SOURCE -- - 0/0
PLUMBING
I
n
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'� MECHANICALIfW
Plan Check No. t j
This Permit covers work to be done on private property ONLY.
sidewPlks,
GRADINGIFILL
50
Any construction on the public domain (curbs,
separate permission.
STATE SURCHARGE
driveways, marquees, etc.) will require
Permit Application: 180 Days
STORM DRAINAGE FEE
Permit Limit: 1 Year - Provided Work Is Started Within 180 Days
••Applicant. behalf of his or her spouse, heirs, assigns and
EKG. INSPECTION FEE
on
interest, agrees to indemnity, defend and hold
v, successors In
w harmless the City of Edmonds, Washington, its officials,
and agents from any and all claims for damages of
e
employees,
< whatever nature, arising directly Or indirectly from the Issuance
this permit shall not be deemed to
PLAN CHECK DEPOSIT
vi
T of this permit. Issuance of
modify. waive or reduce any requirement of any city ordinance
Clly'a ability to enforce any ordinance
TOTAL AMOUNT DUE
Val
° nor limit in any way the
provision"
I hereby acknowledge that I have read This application; that the
ATTENTION
APPLICATION APPROVAL
Information given is correct: and that I am the owner, or the duly
the Owner. I agree 10 comply with city and
THIS PERMIT
This application is not a permit until
authorized agent of
laws regulating construction: and in doing the work aulhorfz-
UTHOR THE
ONLed
signed by the Building Official or his/her
state
thereby, no person will be employed in violation of the Labor
WORK NOTED
Deputy: and fees are paid, and receipt is
Cotle of a State of Washington relating to Workmen's Compensa-
acknowledged in space provided.
tion Ins r nce and P.0 18.2i. PATE SIGNEp
INSPECTION
DEPPECTIO
DPTE
DINNER AGENT( _,
Iff Fzo_�,
CITY OF
EDMONDS
GFFICIALS SIGNATURE
PEL v DPTE
CALL FOR
PSEO
AJ�FENTION
INSPECTION
a
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
HAS BEEN pBEENDE N APPROVAL
LUBC
n/�f
I2 LL
771 -OO
ORIGINAL — File YELLOW —Inspector
GRANTED
AN CERTIFINAL CATE NOFE OCCUPANCY HAS CTION
PINK — OxceT GOLD — Assessor
SECTION 100
102 87
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Fooling ....................
Well .......................
Pier/Porch................
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Retaining Well............
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Slab l nsulatlon............
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PLUMBING:
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Underground .............
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� Rough -In .................Ln
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LLO.
Commercial Final.,......
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HEATING:
u. n:
Gas Test .................
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Gas Piping ................
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Equipment ................
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Commercial Final.........
0
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EXTERIOR SHEATHING
—1
NAILING ....................
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FRAMING ....................
F- F,
11- C'
INSULATION:
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Floorinsulatlon...........
p~i
Wall Insulation ...........
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Ceiling Insulation.........
' SHEETROCK NAILING......
SPECIAL INSPECTION ......
ti J
MISCELLANEOUS
FINALAPPROVAL
oil
FOROCCUPANCY..........
32 X