960585M
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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DEDICATION
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SIZE
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ENGINEERING MEMO DATEn
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ZIP
TELEPHONE NUMBER
`21903
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NO/
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NE/VIE.
FIRE/MEMO D/ntEDf /
IF I ICFNSF NIIAmFR
EXPIRATION DATE
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SIGN AREA
ALLOWED PROPOSED
EPA REVIEW
COMP�SE,TE EXEMPT
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ADB
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,at nescrTnhnR of PrODerty - include all easements
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Pro
TawrceAetcount /��Ylry�vy b
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Pal No
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RESIDENTIAL
PLUMBING
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CO MERCIAL
MECHANICAL
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APT. SLOG.
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lit Att,nEl
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BIGN
GRADING
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OVE
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SPOOL
SWIM
DLI.IUI.ISH
❑ INSERTW.ODS
INSERT
HOT TUBI
AGE
RETAINING WALL/
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❑
CARPORT
ROCKERY
RENEWAL
)EX
ITY{rSE BUSINESS ORA TIVI VPLAIN:
i'VAy
1
NU1.IItEn //��
NUMBER OF �n
DWELLING
CRIT AL
AREAS
/7
vi TRIES /
�W
IINIiS (�/
NUMBER -
DESCRIBE WORK TO
BE DONE (ATTAgHMOT PLAN)
ma
m
SETBACKS — FEET M 1 HEIGHT LOT COv
FRONT / 5 SIOE V REAR 4
REMARKS
/51�.S,a..! 1z)(ABLS r2
/,,A.%,ern✓i= *j3;75/C.
H C E BV R UI EO TYPE N�RUCTIE� SPECIAL INSPECTOR
ES ^}0Q41
ON ACOD
Rnr
REMARKS U4
PROGRESS INSPECTIONS PER UBC 305 /
O/4LItIeIPA,'AP 0rrK �Ni9�✓/
car �vv�3 y Cyr svL1G✓sOw'1/,
FINAL INSPECTION REQUIRED
FEE
VALUATION
PLAN CHECK FEE
4 /
BUILDING
4 %fj'/
�D
r, S IIRCE
GLAZING r
%
7 I
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PLUMBING
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PC. �T
Plan Check No. l� �/7 `T
MECHANICAL
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• , `
_
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
SQ
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
/
,o successors In interest, agrees to indemnity, defend and hold
---'
w narmless the City of Edmonds, Washington, itsolficgeials,
`�
(off
employees. and agents from any and all claims for damas
whatever nature, arising directly or indirectly from the issuance
T Of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
o moody, waive or reduce any requirement of any city ordinanceA�/—,
>, nor Nmlt in any way the City's ability to enforce any ordinance
TOTAL AMOUNT DUE
9/ ;�' 2173'I
provision."
an
I hereby acknowledge that I have read this applicatlon; that the
ATTENTION
APPLICATION APPROVAL
Information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply with city and
state laws regulating construction: and in doing the workauthoriz.
THIS PERMIT
AUTHOP12ES
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 Stale of Washington relating to Workmen's Compensa•
WORK NOTEo
Deputy; and fees are paid, and receipt is
I ton Ir wance and ROW 1 .27.
INSPECTION
acknowledged in Space provided.
51Gr1. II+E Otl E i t DATE IGNED
DEPARTMENT
CITY OF
OF I A SIGN TIRE PiE
EDMONDS
r Zh-A �P
ATTENTION
CALL FOR
INSPECTION
PELE ASED °' 0 TE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
J7
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
�� _o��o
ORIGINAL — F. •e YELLOW — Inspector
A CERTIFICATE OF OCCUPANCY HAS BEEN GRANTED, UBC
CHAPTER 3
10257
PINK — O.-e• GOLD — Assessor
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ........ .........
�(0 'SQ�IVhW►rw FOUNDATION: AtY 6T%w_lQ�
✓✓� Footing ....................
-" _••(/ wail .............. ei s
r
�_ � y t • � ~( Pier/Porch................
Retaining Wall............
�fV�^ Slabinsulation............
�/ ram- �i•1+•t7 .
PLUMBING:
Underground ......... �
ja Q C �JRough-in
. • • /1�"Rough-In .................
/A14- Commercial Final ........
-•" "- �~
�/•�/'� HEATING:
�J0/l , Gas Test ................s,;.:.-----J� F
ry� y • �Jo' �%
- .3 • GQ 7 vltV/ Gas Piping ..::...........: .
j�S.'t' dJiiL+ i...- ;...-Equipment • ....;e;;....... �.. �
Commercial Final ...........
-
TO•,����NGcN`t EXTERIOR SHEATHING . r C J 7, p T IV3'2-"'77$ S•zd•R�
FC�S���rFy(�T'1cNC•fSNAILING ..................�-.-_'+ ,I r
FRAMING ............ .•......:,� -� ? ^T r �o • �' 7
4 '347 A rZ. INSULATION:
FKAW,A-4- 8-1 Floorinsulation..........7
7 G Zko-11 �• Wall Insulation .......... �-' �---d _,'sv ` Z,0 - � f
°�!J'�' Ceiling Insulation.........
� • ? • q? ..3=mac, , .. - -
�O- SHEETROCICNAILING.....
�r
SPECIAL INSPECTION ......
4• Y •tZ
1'1
p - l9~�� RADON MONITOR AT SITE. —
5�
` pJ FINAL APPROVAL
,,., 9 ,
T .3- �` ( jt ~S F 9ftS ,OCCUPANCY...........�
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