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CITY OF EDMONDS
ZONE PERMIT 9�(I643
NUMBER
CONSTRUCTION PERMIT APPLICATION
QB UITE,APTv
ADDRESS / ';/ �-
OWNER NAME NAME OF BUSINESS
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LEGAL DESCRIPTION CHECK
SUBDIVISION NO
LID NO
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved ❑
CITY ZIP
TELE HONE NUMBER
EXISTING REQUIRED DEDICATION
PROPOSED
RW PermKR d D
Useerml
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Sldawel4 ReR-eduned ❑
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES D NO ❑
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ADDRESS
REMARKS
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CITY ZIP
NUMBER
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NAME
ADDRESS
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ENGINEERING MEMO DATED REVIEWED BY
CITY IZI
.TELEPHONE NUMBER
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FIRE MEMO DATED REVIEWED BY
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STATE LICENSE NUMBER E%PIRATION DATE
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VARIANCE OR CU
AOB X
SHORELINE e
Legal Description of Property - Include all falliftisnts
SEPA REVIEW
SIGN AREA
HEIGHT
zG
COMPLETE I EXEMPT
EXP
ALLOWED PPOPOSEO
ALLOWED PROPOSED
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
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Tax ADCDYrill I 1 '7 /^ O D/ �\
Parcel No.
LOT AREA
PLANNING REVIEW BY
GATE
ElNEW RESIDENTIAL y� PLUMBINGMECH
REMARKS
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ADDITION COMMERCIAL CHANGEOFUSE
ElREMODEL APT. 9LDG. SIGN
CHECKED BY TYPE10�F 0 STRUCTION CODE
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GIDEMOLISH
ElREPAIR ❑GRADING CYDS ❑ FENCE K—�
NSERWOODT TOVE HoM POOL
CARPORT ROCKE YGARAGEG WALU ❑ RENEWAL
SUBSPA REQUIRED SPECTORREA
13 YES
OOCADUPANT
REMARKS
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PROGRESS INSPECTIONS PER UBC 108 Z
(TYPE OFU� BUSIN soRAcr1URY)EXPLAIN:
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NUMBER
OF
STORIES
DESCRIBE WORK TO BE DON�(ATTACH
NUMBER OF
DWELLING /
UNITS i
PLOT PLAN)
CRITICAL
AREAS
NUMBER
/
FINAL INSPECTION REQUIRED
VALUATION
all
FEE
PLAN CHECK FEE
BUILDING
HEATSOURCE.
GLAZING
D/D
PLUMBING
3
Plan Check No.
MECHANICAL
This Permit covers work to be done on private property ONLY.
GRADINGIFILL
Any construction on the public domain (curbs, sidewPlks,
STATESURCHARGE
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
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successors In interest, agrees to indemnify, defend and hold
harmless the City of Edmonds, Washington, its officials,
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
modlfy, waive or reduce any requirement of any city ordinance
nor limit in any way the City's ability to enforce any ordinance
provision."
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
I 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
ed thereby, no per, I be I d in violation of the Labor ONLY THE
Code 01 the State Wa on r ati g to Workmen's Compensa woRK NOTEo
tion Insurance d 8 7. INSPECTION
This application is not a permit until
signed by the Building Official or his/her
Deputy: and fees are paid, and receipt is
acknowledged in space provided.
SIGNATURE rOW(R O A Nt pATE SIGNED DEPARTMENT
CITY OF
OFF DATE
'$ SIGNATURE
EDMONDS
9 11,l
CALL FOR
ATTENTION INSPECTION
RELEASED BY DATE
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE ��� _®Gio
UNTIL A FINAL INSPECTION HAb BEEN MADE AND APPROVAL OR
A r`FRTIFICATF OF OCCUPANCY HAS RFFN GRANTED. UBC
ORIGINAL - File YELLOW - Inspector
PINK - Oa•rer COLD - Assessor 4-
SECTION 109
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ....................
Well ........................
Pier/Porch................
Retaining Wall............
Slab Insulation............
PLUMBING:
Underground .............
Rough -In .................
Commercial Final ........
HEATING:
Gas Test .................
- Gas Piping ................
Equipment ................
Commercial Final .........
EXTERIOR SHEATHING
NAILING ....................
FRAMING ....................
INSULATION: -
Floorinsuiatlon...........
Wall Insulation ...........
Ceiling Insulation.........
SHEETROCK NAILING ......
SPECIAL INSPECTION......
MISCELLANEOUS
FINAL APPROVAL
FOR OCCUPANCY. ....��
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