990543.pdfPERMIT EXPIRES
Z°IE NUMBIER 990343
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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OWNE ME/NAME OF SUSINES
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LEGAL DESCRIPTION CHECK SUBDIVISION NO, LID
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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LEGAL DESCRIPTION OF PROPERTY INCLUDE ALL EASEMENTS
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PROP TY TAX CCOUNT P RCEL NO.
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❑ ADDITION ❑ COMMERCIAL ❑ CHANGE OF E
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❑ REPAIR ❑ GRADING CYDB ❑ 1 % FT
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GARAGE ❑ RETAINING WALL ❑ RENEWAL
❑ CARPORT
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ITVPE OF USE. BUB SS OR ACTIVITY) E%PLAIN.
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DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING LOT SLOPE°_
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PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK T
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
MAROUEES,ETC.) WILL REOUIRE
DOMAIN (CURBS,SIDEWALKS.DRIVEWAYS.
SEPARATE PERMISSION.
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PERMITAPPLICATION:START80 S
PERMIT LIMIT: tYEAR -PROVIDED WORK IS STARTED WITHIN ISO GAYS
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOR
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY
EMPLOYEES. AND AGENTS FROM ANY AN
'
EDMONDE. WASHINGTON, ITS OFFICIALS,
¢ ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
p FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
ORDINANCE
PLAN CHECK DEPOSIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY
ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
NOR LIMIT IN ANYWAY THE CITV'S
I�
TOTAL AMOUNT DUE
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT. ANO THAT AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
WITH CITYANDSTATE LAWS REGULATING CONSTRUC
CALL T TFis appli¢al�on ;s nol; pormil pntil ¢ig^atl EYlna
THEOWA'ER. I AGREE TO COMPLY
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
RELATING TO
FOR INSPECTION Bu�mmp Qltic�al p� nlsmpr 17eppb- a^a Fp¢: asp papa. a^tl
is,acknowloCBptl ^ aco p�ovitlptl
IN VIOLATION OF THE LIBOR CODE OF THE STATE OF WASHINGTON
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\YORKMEN'B COMPENBA ION INSURANCE AND RCW t 6.2T-''
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(425) OFF I SSIG'ATUFE ^-�077-
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NAT (OWNERO ENT) 11V/n 1\1 v/
771-0220 RELE EE
ATTENTIO �2� vd ��� 33
NIL
- IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING R STRUCTURE
FILE YELLOW - INSPECTOR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI•
ORIGINAL -FILE
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OFF
NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REQUIRED DEDICATION ��
PROPOSED
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METER SIZE
LINE 812E
NO. OF FI%TURFS
PRV REQUIRED O
YES ❑ NO ❑ �
REMARKS �
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ENGINEERING MEMO DATED REVIEWED BV
FIRE MEMO DATED REVIEWED BY
VARIANCE OR CU
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SHORELINE M
SERA REVIEW
COMPLETE I EXEMPT
SIGN AREA
;ALLOWEDPROPOSED
HEIGHT
ALLOWED PROPOSEDEXP
LOT COVERAGE
ALLOWED PROPOSED
UIRED SETBACKS (FT.) PROPOSED
ONT SIDE REAR
SETBACKS (FT.1
FRONT UPSIDE REAR =
LOT AREA
PLANN�ING!LREVI � DATE g
CHECKED BY
Tv�" DF CONSTRUCTION
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OCCUPANT
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SPECIAL INSPECTOR AREA
REQUIRED ❑ yp8
OCCUPANT
LOAD
REMARKS O
PROGRESS INSPECTIONS PER UBC 108 -
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FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
BUILDING
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PLUMBING
MECHANICAL
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GRAOINGIFILL
STATE SURCHARGE
STORM DRAINAGE FEES
S EKG. INSPECTION FEE
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pler/Porch
Retaining Well ...........
Slab insulation
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING
FRAMING ........................
INSULATION ................... .
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
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