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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITELEPHONE
2L W.0
CITY
ZIP ITELEPHONE
NAME
CBL#
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ADDRESS
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CITY
ZIP
cl�_710
TELEPHONE
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—
C1 L
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED
ON
PROPERTY AX ACCOUNT ACEL NO.
0 00
NEW
lig" RESIDENTIAL
ADDITION
F_� COMMERCIAL
REMODEL
I
F-1 MULTIFAMILY
REPAIR
GRADING
CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINEft)OR ACTIVIT EXPLAIN:
K_t
NUMBER
NUMBER OF
OF
DWELLING
I
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING %
PLAN CHECK NO:
PLUMBING MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
( x Fr
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
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 APPLICATION: 180DAYS
PERL41T LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF [Its Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND fIOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIYOR INDIRECII-Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 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
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRU
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS=RAffE AND RCW 18 27.
TURE DATE GNED
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(OWNER (11 AGrNlj,,;�
USE
70NE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT oCol
NUMBER,�7j(/
SUITE/APT#
LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
(3
Bw Permit sequired
E3
Strom Use permit Req'd
13
inspection Required
0
Sidewalk Required
E3
underground
Wiring required
E3
PRV REQUIRED
YESO NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEER
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
ALLOWED
LOT COVERAGE
PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
DATE
DATE
SHORFLiNr —oRADB# INSPECTION I BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED ALLOWED , PROPOSED
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REQUIRED SETBACKS (FT) PROPOSED SETBA
ECK� EAR'
FRONT SIDE REAR FRONT L/R SID
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LOT AREA PLANNING REVIEWED BY DATE
OCCUPANT
GROUP
OCCUPA
SPECIAL INSPECTION JAREA
REQUIRED F-1 YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOD
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee,
CALL
OR INSPECTION
(425)
1_0
771-022
j
FEE Description FE
State Surcharge
City Surcharge L
Base Fee
E
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # 233"C
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Oflicial or his
)her Deputy: and Fees are paid, and
receipt is acknowledged in space providop-
0 01�&IA ri Ar IIIATE
FASED BY
(OTENTION E)ff 1�3
(
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFITIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
4
0111GINAL FILE YELLOW - INSPECTOR
PINK - OWNER COLD - 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:
....................
6as Test.
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
OCCUPANCY ..................
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