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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATJ=- LICENSE NUMBER EXPIMTION DATE I CHMKED BY
PROPERTY TAX ACCOUNT PARCEL NO. -76(:2�
NEW RESIDENTIAL PLUMBING / MECH
A WCOMPLIANCE OR
ADDITION COMMERCIAL 1:1 CHANGE OF USE
REMODEL MULTIFAMILY E] SIGN
REPAIR C] GRADING o FENCE
CYDS ( X FT)
DEMOLISH 13 TANK OTHER
EiGARAGE Ei RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BU OR ACTIVITY) EXPLAIN:
CRITICAL
OF WELLIN AREAS
0 STORIES UNITS NUMBER
NUMBER NUMBER OF
D
DESCRIBE WORK TO BE DONE
ELM,%
HEAT SOURCE GLAZING % LOT SLOPE %
2!�� 1 1
A CHECK NO: I VESTED DATE
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.
PERMIT APPILICATION: ISO DAYS
PERMIT LJIMIT: 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
N 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 CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS 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 STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT ON OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN!S COMPENSATION INSURANCE AND RCW 18.27.
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FPERMIT
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USE PERMIT
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PLAT NAM E/SU BDIVI SION NO.
LOT NO,
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appfayed
RW Permit Required
Street Use Permit R&Nq'd
EXISTING — PROPOSED
Inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION— FT
Underground
Widritirequired E3
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES13 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
GAS PIPE TEST MUST BE
ENGINEERING REVIEWED BY uc mutocr i cu DATE
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VARIANCE OR CU SHORELINE OR AD1111 I INSPECTION PBON
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT:) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
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REMARKS
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engn Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapoinsp.
Total Amt. Due
Recording ee
Receipt #
CALL
FOR INSPECTION
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771-0220
APPLICATION APPROVAL
Th s application is not a permit until signed by the
Buildinig Official or his/he( Deputy: and Fees are paid, and
ecoiptisucknowlodged in5pace provided.
I L 11 URE DATE
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-RELE—ASED
BY f DATIf
ATT1ENTION Off 1333
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR,
DATE APPROVED
'SETBACKS ............. ......
F0.UjNDATJON:
Footind ........... i .... i .........
Wall............. i..: ............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
o h ..............
R '66 -In
Cdmm.erciaI Final
-HEATING—.
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRA?4ING ..........................
AMROOft F
'W`6 ......
IN96 di
..........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
A
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
PfiN,ER NAME/NAME OF BUEUtu5ES
L I I-e
MAILING ADDRESS
10 / -2-
CITY ZIP ]TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
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CITY TELEPHONE
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STAW LICENSE NUMBER EXPI TION DATE CHWKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
E] NEW RESIDENTIAL PLUMBING / MECH
A X COMPLIANCE OR
ADDITION [] COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING CYDS FENCE X FT)
1771 DEMOLISH TANK OTHER
GARAGE RETAINING WALL F RE SPRINKLER
CARPORT ROCKERY ME ALARM
(TYPE OF USE, BUSIqEqS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
I".
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PERMIT EXPIRE
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4 / ILL
USE PERMIT
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NUMBER
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JOB
ADDRESS V/ 1/��/
UITE/APT#
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street Use Permit Roq.d
EXISTING - PROPOSED
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
n tg
Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YESO NO 1:1
REMARKS
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OWNER/CONTRACTOR
ff.§N%�FR EROSION CONTRUL/DRAINAGE
IFS111 NIIIIII.Q11"
RF 12
ENGINEERING
FIRE REVIEWEDBY VIV1111 Lu
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VARIANCE OR CU
SHORELINE OR ADB#_j
INSPECTION
BOND
REO'D
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POSTED
OYES 13NO $
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE
EXEMPT
ALLOWED
PROPOSED
ALLOWED
PROPOSED
EXP
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I
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
URSIDE REAR
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HEAT SOURCE GLAZING % LOT SLOPE %
2i:5;Q I I —
A CHECK NO: I VESTED DATE
CHECKEDBY JTYPEe,�7N TRUCTION 1;14 OCCUPANT
GROUP
1779
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [3 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REG'D_j
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VALUATION ted spaces. UMC 815.1.7
or
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
X DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2-
5 PERMIT APPLICATION: 100 DAYS
116 PERMIT UM1r I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORRECM AND THAT I AM THE OWNER, OR THE 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION1
Building Official or his/her Deputy: and Fees are paid. and
receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
11 RE DATE
0 1 So U
SIG U E (OWN R OR E
DATI SIGNED
tT
771-044V
A
RELEASED BY
NTION Zl/
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
I—
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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