20040006.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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PERMIT EXPIRES
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STATE LICENSE NUMBER EXP17RION ATE ECKED REO'D POSTED
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LJA7S_�H 16�3 4L 40�5 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. 17 COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
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E] NEW O�ZESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
REPAIR GRADING CYOS FENCE
( X FT) REMARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) IN: CHECKED'BY TYPE OF nNSTRUCTION jjV OCCUPANTe
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tu NUMBER NUMBER OF CRITICAL
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOID 5
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Description FEE Description FEE
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HEAT 0 CE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLA114 CHECK NO: VESTED DATE Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION ---------
cn 'APPLICANF, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
LU IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLYOR INDIRECILY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE Landscapeinsp. Total Amt. Due
0 V/;
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt #
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 APPLICATION APPROVAL
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/tier 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 COMPENSATION INSURANCE AND RCW 111.27. %1C I A I S01 SIGNATURJ� ATE
SSaf(OWN R G D GNED (425)
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771-0220 RFIFAf 0 BY
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEE14 MADE AND APPROVAL Oil A CERTIFI- ORIGINAL FILE - YELLOW-INSPLCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD-ASSESSorj
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-RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
PFTBA.CK-S ......................
FOUNDATION:
Footing ......................
Wall..........................
Pie0orch ................. z
0
Retainihg Wall ............
0
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Slab Insulation ..........
PLUMBING: :n
Underground ............. M
C
M
Rough -In ................... 0
0
0 C
Commercial Final ...... K
M
HEATING: M Z
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Gas Test .................... >
Gas Piping .................
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Equipment ................. n
Commercial Final .......
MM
EXTERIOR SHEATHING 0
0
NAILING .......................... 0 M
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FRAMING ........................ Q
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FIRST FLOOR FRAMING...
INSULATION ................... ;U
Floor Insulation ......... >
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Wall Insulation ........... --I
Ceiling Insulation ....... (n
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SHEETROCK NAILING ... --I
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SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR 44 -
OCCUPANCY ..................
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