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PERMIT EXPIRES
CITY OF EDMON(�S
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ATTE TI
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE
YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
5•9S
1
CONSTRUCTION PERMIT APPLICATION .JOB
SUITE/APTA
ADDRESS �(�, �[ c , , 1,
Off' I •J �1 W
OWNER NAMEINAME'OF BUSINESS
LEGAL DESCRIPTION CHECK
SUBDIVISION NO.
LtD NO.
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MAILING AbD S
��� L ��
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING REQUIRED DEDICATION—
PROPOSED
TEscP apPwpe ❑
WN PermA Pepunae ❑
Sueer use permn Aege ❑
Invpaclipn Aepnned ❑
saewpix appuaee ❑
CITY ZIP
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TELEPHONE
L I
NAME
METER SIZE
LINE SIZE
N0. OF FIXTURES
PRV REQUIRED
YES ❑ NO ❑
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ADDRESS
REMARKS
CITY ZIP
TELEPHONE
NAME
1
V
ENGINEERING MEMO DATED REVIEWED BY
�
ADDRESS
ZIP TELEPHONE
FIRE MEMO DATED REVIEWED BY
VARIANCE OR CU
ADBa
SHORELINE a
z
STATE LICENSE NUMBER EXPIP TIO DATE
CHE NE08Y
O�
SERA REVIEW
COMPLETE I EXEMPT ALLOWED
EXP
SIGN AREA
PROPOSED
HEIGHT
ALLOWED PROPOSED
O
I.:
u¢Oi
LEGAL DESCRIPTIO OF PROPER -INCLUDE ALL EASEMENTS
LOT COVERAGE REQUIRED
ALLOWED PROPOSED
SETBAONS.(FT.1
FRONT SIDE BEAR
PROPOSED SETBACKS (FT)
FRONT, IJq BIDE REAR
J
.e
S
PROP T T O T P EL NO.
LOT AREA PLANNING
REVIEW SY DATE
❑ Npyy ❑ RESIDENTIAL PLUMBING/MECH
REMARKS
AD01TION ❑ COMMERCIAL COMPLIANCE OR
❑ CHANGE O: USE
T_
❑ REMODEL ❑ APARTMENT ❑ .SIGN
GOADING FENCE
❑ REPAIR ❑ CVDS ❑ % FT)
3'V
V
TVPF. OF CONSTR C�TfQN�
/VY
CO17E OCCUPANT
GROUP �3
OTHER
❑ DEMOLISH ❑ .TANK - ❑
WALL❑RENEWAL
SPECTOR AREA'❑CARPORTRETAINING
[SPECIAL
❑YES
LOAD
(TYPE OF USE. BU51 S� CTIVITY) EXPLAIN:. -
REMARKS
PROGRESS INSPECTIONS PER UBC 108
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NUMBER NUMBER Of.
OF - DWELLING
STORIES UNITS /
CRITICAL
NUMBER
OESC EWO KTOB ONE
�--�I, �U
FINAL INSPECTION REQUIRED
VALUATION
FEE
PLAN CHECK FEE
HE TS/URGE GLAZING 9:
LOT SLOPE
BUILDING
PLUMBING
n
PL%MCHMX NO:
VESTED DATE
MECHANICAL
p�J,�Or,A
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
— DOMAIN (CURBS,SIOEWALKS,DRIVEWAYS. MAROUEES,ETCJ WILL REQUIRE
� SEPARATE PERMISSION.
GRAOINGIFILL
STATE SURCHARGE
PERMIT APPLICATION: 1B0 DAYS
PERMIT LIMIT: pYEAR- PROVIDED WORK IS STARTED WITHIN 1B0 DAYS
STORM DRAINAGE FEES
L1 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCGESORS
� IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD ((ARMLESS THE CITY OF
EOMONOS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGESOF WHATEVER NATURE, ARISING DIRECTLY ON INDIRECTLY
9 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
p DEEMED TO 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.'
ENO. INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; TH'�f '. INFORMATION
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DULY AIJ Ix4., .!ED AGENT OF
THE OWNER. (AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUE
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS SURANCE AND RCW I8.27.
CALL
FOR INSPECTION
(425)
%
APPLICATION APPROVAL
This applaauon is notapormil until slpnod py this
Buiamg onlplal or hipJnpr Dppwy: and Fpas arp pain. ane
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SIGNAT NE AGE
DATjIE�S/11 NED
OFRCIA SSIGNAT � DATE
A7'jG(
RELEASED OY OnrE
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ..................
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Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
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Rough In ............
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Commercial Final
HEATING:
ca
Gas Test ....................
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GasPiping
.................
Equipment ................
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Commercial Final
JD
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ..............
INSULATION ...................
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Floor insulation
D. r
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Wall Insulation ...........
C (j)
Calling Insulation
fn e),
NAILING
;
SHEETROCK
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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ATTE TIC?N�
O USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL
- FILE YELLOW - OR
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINALIOWNER
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 10A
GOLD ASSESSOR
CITY OF E®MON®CJ
PERMIT: �
_NUMBER