20030776.pdfDATE RECEIVED
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CITY OF EDMONDS
C CONSTRUCTION PERMIT APPLICATION
OWNER ME/NAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATIOq
DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL
PLUMBING / MECH
0 ADDITION D?-COMMERCIAL
COMPLIANCE OR
GE OF USE
REMODEL MULTIFAMILY
06 IGN
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GRADING
REPAIR CYDS
o FENCE.
( _X—F7)
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
FIRE SPRINKLER
CARPORT ROCKERY
FIREALARM
UWE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
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NUMBER OF
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STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO- VESTED DATE
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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, SIDEWALKS, DRIVEWAYS, UARQUEFS, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
PERMIT LIMM I 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
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, 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 C17Y ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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 WITH CITY AND STATF LAWS REGULATING CONSTRLIC-
TION; AND IN DOING THE WWOR AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
CC
IN VIOLAT!ON OF THE , CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN S COMPENSA�J WRANCE AND RCW 18.27.
SIGNATURE GE DATE SIGt/D
PERMITEXPIRES 41114612�1
UbE PERMIT
ZONE NUMBERC��S—e!�)77)6
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP MY Parmh Required
Street Use Peffnh Req'd
EXISTING — PROPOSED-- Inspection Required Ell
Siderwalk Required 13
REQUIRED DEDICATION— FT — UrderWound
Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO C3 0z
REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE z
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SE -PA REVIEW
SIGN ARtA
HEIGHT
COMPLETE EXEMPT
ALLO D PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
REVIEWEDBY DATE
REO'D I PROVIDED
LOT AREA
PLANNING
REMARKS
CHECKED BY ITYPE Cj��M I CEMOCCUPANO
GRO
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I GOMINAL INSPECTION REG-D
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
CitySurcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
APPLICATION APPROVAL
This application Is not a permit until signed by the
Building 0111clall or his/her Deputy; and Fees are paid, and
receipt Is acknowledged In space provided.
OF&FIALS&SGIURE , DATE
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IL
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DATf
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 1(1NS;fCTO
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
'M/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
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INSPECTOR DATE APPROVED
SETBACKS .......................
FOUNDATION:
Footing......................
W
Wall..........................
Pier/Porch .................
C):
m:
Retaining Wall ........
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Slab Insu a n
..........
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PLUMBING:
m
Underground .............
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Rough
-in ...................
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Commercial Final
ID
.....
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'HEATING:
'Gas Test .....................
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..Gas Piping ... ..............
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Equipinent . ....................
Commercial Final .......
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EXTERIOR SHEATHING
NAILING
..........................
FRAMING ...... .......
FiRST:FLoOR FRAMING...
INSULATION ...................
Floor Insulation
..........
—Wall Insulation ..... ......
Ceiling Insulation
SHEETROCK NAIL ING
...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
I
)$ATE RECEIVED
NMI W5 (/PnPf&"f q
CITY 0 FEDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP JTELEP�HONE
NAME CBL#
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CITY ZIP TLTj?E
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STATE LICENSE NUMBER EXPjRATIOV DATC I. KE
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PROPERTY TAX ACCOUNT PARCEL NO f 11
NEW RESIDENTIAL PLUMBING/MECH
COMPLIANCE OR
ADDITION Iffe'COMMERCIAL E OF USE
REMODEL MULTIFAMILY S tIG N
GRADING FENCE X
REPAIR CYDS Fri
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLERT
CARPORT 13 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVTM EXPLAIN:
Se Wk` L
NUMBER NUMBER OF IL CRITICAL
OF' DWELLING AREAS
STORIES UNITS
DESCRIBE WORK TO BE DONE
0`3
PERMIT EXPIRES 4VUL
UbE PERMIT
ZONE NUMBERC<09—�9 7
JOB SUITE/APT#
ADDRESS
Lidl. j;;j&.j;; 1\1
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PIAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APpcoved
AW ParrrJt Required
Streel use Perm" Rao
EXISTING — PROPOSED
Inspectlo Required
Sidewsbc Required
REQUIRED DEDICATION- Fr
Under"M
Wkirtgrequired
METER SIZE
LINE SIZE -1
I
NO. OF Fix-runEs
' PRV REQUIRED
YESD NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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D AT A LA-fFf, INAlf-
ENGINEERING REVIEWED BY DATI
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FIRE REVIEWED BY DATi
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VARIANCE OR CU
HORELINEORADB#
I INSPECTION
RE4�D�
PBONDO
OSTE
AimA .1[3YES
YkNO
$
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
ALLOW'D PROPOSE9
ALLOWEY PROPOSED
EXXE.MPT
,
EXP
f CbV9RAGE
REQUIRED SETBACKS t]FT)
PROPOSED SETBACKS (Fr.)
4 toWED PROPOSED
FRONT SIDE REAR
FRONT LIRSIDE REAR
PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ`13 I PROVIDEDI
k�
REMARKS
CHECKED BY ITYPE
GROUP
SPECIAL INSPECTION JARE�,,,, Q1. OE;UU
REQUIRED [3YES r LOAD
IREMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION AEG-0
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'Plan Check
A
HEAT SOURCE GLAZING % -, LOTSLOPE%
Building Permit
PLAN CHECK NO. VESTED DATE
Plumbing
Mechanical
THIS PERMIT MITIIRIZFS ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DOME ON PRIVATE PROPEFITY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMff6MM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engir. lnsp�Bction
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS ANDSU6�ESORS
Fire Review
.1
IN INTEREST, AGREES TO INDEMNIFX DEFEND AND,HOID HfflWLIESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPhOYEES. AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE- OF. THIS FIERmrr. ISSUANCE OF Tt)IS PERfArr sHALL'NOT BE
MODIFYWAIVt OR REDUCE ANY REQUIREMENT bF ANY CITY ORDINANCE
La"Pafe Insp.
DEEMED TO
NOR LIMIT IN ANY WAY THE CrnrB ABI2. TO ENtORCE ANY ORDINANCE PROVISIO
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 13 CORRECT; AND THAT I AM THE � . r TEHi� DULY AUTHORIZED AGENT Oj:
THEOWNER. I AeREE TV COMPLY WITH-� ffy� AN% XT LAWS REGULATING CONSTRUq-
CALL
TION; AND IN DOING THE WORNI, ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE ODE 0 THE STATE OF WASHINGTON RELATING Tq
Col
LAP%C
FOR INSPECT110N
WORrJAENS CoMPENSA4 NFRANCE AND RCW 10.27.
SIGNATURE (OWNfA1;dj DATE SIG D
A3
tag 5
771-0220
ATTE06N
EXT 1333
Description FEE
State Surcharge
City Surcharge 00"-
Plan Chk. Deposit
Receipt
Total Amt. Due
1 Receipt #
APPLICATION APPROVAL
This application Is not a permit unto signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is ccknowiodgod in space provided.
FMIALS SJGNATURE , PATE f
BY
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I tz4XOZ611�4 - /I = evyf -
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE -'YELLON6NSACTC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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