20000903.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY 9 ZIP EJL7
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NAME
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ADDRESS
ZIP I TELEPHONE
NUMBER —1-11L
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0 ADDITION
COMMERCIAL
CEA'DTEMRTN
[3 COMPL ANCE OR
CHANGE OF USE
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APARTMENT
C] SIGN
REPAIR
GlAll"I CYDS
C] FENCE
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TANK
OTHER
ci GARAGE
CARPORT
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F
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C3 RENEWAL
71�
(TYPE2�US�ESS OR ACTIVITYI EXPUIN:
NUMBER
UMBER
OF
DWELLING
PEAS
UNITS
NUMBER
-STORIES
DESCRIBE WORK TO BE DOPE
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C�0,0
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I
1--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, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION,
PE MIT APPLICATI N: 180 DAYS
PERMIT LIMIT.- 1 YEAR . PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
0 !NDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
IN INTEREST, AGREES T
9 EDMONDS. WASHINGTON, TS OFFICIALS. EMPLOYEES, AND AGENTS FRO. ANYAND
X ALLCLAIMS FOR DAMAGESOP WHATEVER NATURE. ARISINO DIRECTLY OR INDIRECTLY
PER ISS A CE OF THIS PERMIT SHALL NOT BE
FROM THE ISSUANCE OF THIS MIT U N
D EMEOTO MODIFY. WAIVE OR
E REDUCE ANY REOUIREMEN1 OF ANYCITY ORDINANCE
0
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVIStON.'
PERMIT EXPIRES .51 -1 1 0 1
7E PERMIT 7_wl�cr--
ZONE NUMBER
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ADDRESS
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_FL�T NAME/SUBDIVISION NO, LOT NO LID NO.
LID FEE S
PUBLIC MIGHT OF WAY PER OFFICIAL STREET MAP ww�_'RP`.;'_
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EXI TING — PROPOSED
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REQUIRED DEDICATION— FT — 1�b V.d
p V REQUIRED
YE 0 NO 0
R MARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
REVIEWED/DATE
FIRE REVIEWED By
DATE
VARIANCE OR CU
SHORELINE OR ADB.
INSPECTION
RED 'D
I PBOND
OSTED
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
Exp I
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LO COVERAGE
_�E_QUIRED SETBACKS (FT)
PRCPoSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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REVIEWED BY DATE
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REMARKS
PROGRESS INSPECTIONS PER USC 108/FINAL INSPECTION REO'Dj' .
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required oil all hot water tanks
Citv Code.
19.30.020 (Cl
PLAN CHECK FEE
BUILDING
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MECHANICAL
GRADING/FILL
STATESURCHARGE
ENG, REVIEW FEES
ENG. INSPECTION FEE
IN EE
PLAN CHECK D5FOSIT
RECEIPT
TOTAL AMOUNT DUE
RE IP
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I HERE ACKNOWLE T APP ICATION� THAT THE
By DGE HAT I HAVE READ THIS
APPLIC ION APPROVAL
N;ZlEN�FOF"AT'ON
AGENT .
GIVEN IS CORRECT. A D THAT I AM THE OWNER, OR THE GUL, ALTRO F
N -
REGULATING CONSTRUC
CALL
T Ippl-Ilb—, 1 u�t,I 11,1d by
F m ..d
THE OWNER. REETO ..PLY WITH CITY AND STATE LAWS
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NWILLBEE.PLOYED
a ld, 01,,.1 , h,, Depuly �d pad.
TION; AND IN DOING , HEWORKAUTHORIZEDTMERESY.NOPERS
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
FOR INSPECTION
—1—Idg.d �F pov.d
WORKMEN'S CD.FENSATIOWI�
,URkNCE AND RCW 18.27.
IF "'All SI RE DATE
ORS IOWCIl -
(425)
c_
771-0220
VEAS.
ATTENTION
EXT/333
ITIS UNLAWFULTO USE OR OCCUPY ABUILDtNG OR STRUCTUREUNTIL
771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...............
Commercial Final
HEATING:
Gas Test ....................
vns
0— (3 -oU
Gas Piping .................
Equipment .................
Commercial Final
EXTERIOR SHEATHING
NAILING .� ........................
FRAMING........................
FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
JIS�o L
OCCUPANCY ...............
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CONSTRUCTION PERMIT APPLICATION
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EQUIRED DEDICATION—
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NAME
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PFV REQUIRE.
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ADDRESS
REMARKS
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OWNEWCONTRACTOR RESPONSIBLE
FOR EROSION CONTROUDRAINAGE
CITY ZIP
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NAME
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FIRE REVIEWED By
DATE
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STATE LICENSE NUMBER
EXPIRATION DAATE
VARIANCE OR CU
SHORELINE OR ADBY
INSP
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AID
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SERA REVIEW
SIGN AREA
HEIGHT
PROPOSED
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COMPLETE EXEMPT
ALLOWED PROPOSED
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EXP I
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OVERAGES,G
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FRONT UPSIDE REAR
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FRONT SIDE REAR
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PARKING
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DATE
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LOAD
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DESCRIBE WORK TO BEJ�rE
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REMARKS
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PROGRESS INSPECTIONS
PER UBC 1081FINAL INSPECTION REO'D
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BUILDING
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PLAN CHECK NO:
VESTED DATE
PLUMBING
MECHANICAL
THIS PERMIT AUTHORIZES ONLY THE WORK NOT D. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPER" ONLY. ANY CONSTRUCTION ON THE PUBLIC
GRADINGIFILL
2 S,MAR UEES, ETC.) WILL REQUIRE
DOMAIN (CLASS. SIDEWALKS, ORIVEWAYMISSIOCI
SEPARATE PER N.
It
PERMIT APPLICATION: 180 DAYS
STATE SURCHARGE
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ENG. REVIEW FEES
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'AP PLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
ENG. INSPECTION FEE
IN I NTEREST. AGREES TO INDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. TSOFFICIALS. EMPLOYEES, AND A ENTSFROM ANYANO
iALLC�IMS FOR DAMAGESOPWHATEVER NATURE.ARISING DIREC_ Q ......... ....
RECEIPT
51 FIR M THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITYORDINANCE
PI-ANCHECKDEFOSIT
0 NOR LIMIT IN ANYWAY THE CITY'S ABILITYTO ENFORCE ANYORDINANCE PROVISION.'
TOTAL AM'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I A THE OWNER. OR THE DULY AU HORIZED AGENT OF
Th Ippllc.111- Is p,,,,l -.1 11pld by th,
THE OWNER. REE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
JAG
PERSON BE EMPLOYED
. CALL
'I,
g, Ojj,I ., 11.1h., D.Puly: .,,,f F .1. b.1d.
TION, AND IN DOING THE WORK AU HORIZED THEREBY. NO WILL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Ipi I, lk—lodgld 11 IPOCO P-ld0d
WORKMEN'S COMPENSATIOWN�AANCE AND RCW 18.27.
� \�FFICIALS SIGNA�URE DATE
<NT
JJE V
IDA TESIGNr
(425)
771-0220
A�LEASED By All
ATTENTION
EXT1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 771-0221
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI
ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
FAX
PINK - OWNER - GOLD - ASSESSOR