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CITY OF EDMONDS
ZONE PERMIT
�7
NUMBER
CONSTRUCTION PERMIT APPLICATION
O NER NAME NAME OF BUSINESS,
JOB
ADDRESS / /JZ I UITE APT n
C •
W���LEGAL
Z
MAILING ADORERS
DESCRIPTION CHECK
SUBDIVISION NO LYp'ryp
o
%5 63/ 7b ?4 tJ.
CITY \ ZIP
TELEPHONE NUMBER
PUBLIC RIGHT OF WAY PEA OFFICIAL STREET MAP
EXISTING
TESCP Approved ❑
RN' Permd Required
C�1
REQUIRED DEDICATION
❑
Slreel
NAME
PROPOSED Inspection
Use Permit Req'd ❑
Required ❑
Sidewalk Required Cl
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AODflE55
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
U
CITY
flEMARKS
YES ❑ NO ❑ 3
i
ZIP
TELEPHONE NUMBER
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NAME
S =A/STr.? u.47i,,%- r
O
Z
�AD✓D�RESS
U
A./y
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ENGINEERING MEMO DATED
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CITY Cj �j ZIPQ
�6���-L` / Ir ��J
TELEPHQONOE N/U�M�ByER
3/ J �Cit/ �I�
REVIEWED BY
FIRE MEMO DATED
U
STAT ICENRE N MBER`
DATE
REVIEWED 6Y
7EXPIRATIIOO�NN
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Legal Description of Prop y -include all easements s
SIGN
ALLOWED
AREA
PROPOSED
REPA REVIEW
COMPLETE
EXEMPT
ADS NO
0
SHORELINE,
a
EXP
m
O
VARIANCE OR CU
PLANNING REVIEW 8Y
DATE
W
-+
Property
SETBACKS —FEET HEIGHT
LOT COVERAGE i
TaXAecdunt
Parcel No. '^C�
FRONT SIDE REAR
REMARKS
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ONEW
'
RESIDENTIAL PLUMBING
ADDITION
((�1
COMMERCIAL
REMODEL
r—I�
/MErHANICAL
APT. SLOG, SIGN
REPAIR ❑ GRADING FENCE
CVOS.%.__Fit
CHECKED aY
TYPE OF CONST UCTI J
CODE
OCCUPANT
DEMOLISH ❑ INSERTWOODSOVE SWIM POOL
INSERT HOT TUB/S'A
SPECTOR
r
AEA
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L
OR
7
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GARAGE ❑ RETAINING WALL/ O
CARPORT ROCKERY
gEOUIRED
❑ YES
OCCUPANT
LOAD
(TYPE
RENEWAL
OF USE. BUSINESS oRACTIVITY) EXPLAIN:
REMARKS
PROGRESS INSPECTIONS PER UBC 305 _
Mtj
yf NUMBER
O OF
NUMBER OF CRITICAL
o
J
$TOflIES
DWELLING AREAS
UNITS NUMBER
DESCRIBE PAK TO BE DONE (ATT PLOT PLAN) ,N'�_ PiAe- T-0 6104- es# -
—ry ���` �g�'~`
INAL INSPECTION REQUIRED
•_G�
VALUATION FEE
PLAN CHECK FEE
HE TSOURCE: GLAZING
BUILDING
DIO
'
PLUMBING
•• Plan Check No.
F
MECHANICAL
Z1
• This Permit covers work lG be done on private property ONLY,
Any construction on the public domain (curbs,
GRADINGIFILL
sldewPlks,
driveways, marquees, etc.) will require SBpafelB pBrmIeSlOn,
Permll Application: 180 Days
STATE SURCHARGE
Permit Llmll: 1 Year. Provided Work Is Started Within 180 Days
STORM DRAINAGE FEE
"Applicant. On behalf of his or her spouse, heirs, assigns and
successors in interest, agrees to indemnify, defend and hold
�••
ENG. INSPECTION FEE
harmless the City of Edmonds, Washington, its officials,
m
li
'
employees, and agents from any and all claims for damages of
i whatever nature, arising directly or Indirectly from the
Issuance
o Of this permit. Issuance of this permit shall not be deemed to
PLAN CHECK DEPOSIT
o modify, waive or reduce any requirement of any City ordinance
x nor limit In any way the City's ability to enforce any ordinance
-
Provision."
TOTAL AMOUNT DUE i�7 may -
I hereby acknowledge that I have read this application; that the
Information given Is correct; and that I am the owner, or the duly
authorized agent of the owner. I agree to comply
ATTENTION AppLICATION APPROVAL
with clty and
slate laws regulating construction; and In doing the work authoriz•
thereby, no person will be employed In violation the
THIS PERMIT This application is not a permit until
C of Labor
Code of thec f Washington r ting to Workmen's Compensa•
-,Ion Insuranc W 18.27.
ONLYAUTHTHE signed by the Building Official or his/her
WORK NOTED Deputy; and fees are paid, and receipt is
IONATURE AGENTI DATE SIGNE7D
INSPECTION acknowledged in space provided.
Q
DEPARTMEN7 --.
E�E
CITY OF OFFICI S r" T D7AT
.
EDMONDS
/
ATTENTION
CALL FOR A LEASED BY DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE
INSPECTION
UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR
A CERTIFICATE OF
771 ORIGINAL File
OCCUPANCY HAS BEEN GRANTED. UBC
CHAPTER 3.
VZLI0 - YELLOW -Inspector /1
I
PINK - Ourer GOLD - Assessor
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .................. .
FOUNDATION:
Footing ....................
Wall.......................
Pier/Porch ............... .
Retaining Wall.... .......
Slab I nsulation ............
PLUMBING:
Underground .............
Rough -In .......... I......
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 ......
RADON MONITOR ATSITE.
FINAL APPROVAL
FOROCCUPANCY......`..--^"�'�I�
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