20030146.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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ZIP
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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0300'ADDITION
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COMMERCIAL
REMODEL
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MULTIFAMILY
REPAIR
1:3
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY).F
.V-LAIP-1
NUMBER NUMBER OF
OF 4,-� 1 DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE /)
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
1:3
PLUMBING / MECH
11
COMPLIANCE OR
CHANGE OF USE
11
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
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CRITICAL
AREAS
NUMBER
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LOT SLOPE %
VESTED DATE
USE
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I PERMIT EXPIRES
PERMIT "-7. 1 1 - ,
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO
LID FEE $
TFSCP Appr-led
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
Street use Pounit Roq'd
EXISTING—'— PROPOSED—
inspection Required
Sidewalk Required
REQUIRED DEDICATION � Fr
underground
wiring roquilOu
METER SIZE
NO. OF FIWXTUR S3
PRV REQUIRED
YE NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiPRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (f7T.)
ALLOWED PROPOSED
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FRONT URSIDE REAR
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CHECKED 13Y ITYPE 7F
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-ir SPECIAL INSPECTION jAffEA
REQUIRED [] YES
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
A SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
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9L PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANT. ON BEHALF OF HIS 09 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
�3 IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, '�ASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
9 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION"
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
FEE Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt # _77)
Total Amt. Due
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, ORTHE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COM NSATION INSURANCE AND RCW 111.27. DATE
I OFFICIALS SIGNNTURE
.�YINE�RO AGEN-0 DATE SIGNED (4251
"1 771-0220 E L !EA;S
- ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
<:7
)I DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
C�s
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
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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
U/
OCCUPANCY ..................
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