20040007.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAI,1E OF BUSINESS
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PERMIT EXPIRES a
PERMIT ;) c)c)q _rzNUMBER I
SUITEIAPTN
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LOT NO. LID NO.
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw PeCIR mit Required
❑
RW Permit Raquirod ❑
Street Use Permit Req'd ❑
EXISTING PROPOSED Inspection Required ❑
Sidewalk Required ❑
REQUIRED DEDICATION Fr Underground
Wiring required ❑
METER SIZE I LINE SIZE NO. OF FIXTURES PRV RE_j�OUIRED
YES ❑ NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING RE
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE HECKED
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PROPERTY TAX ACCNT PARCEL NO.
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❑ NEW I JC RESIDENTIAL X\PLUMBING / MECH
7� COMPLIANCE OR
ADDITION ❑ COMMERCIAL ❑ CHANGE OF USE
❑ REMODEL ❑ MULTIFAMILY ❑ SIGN
❑
GRADING ❑ FENCE X FT) REPAIR ❑ CYDS
OTHER
❑ DEMOLISH ❑ TANK ❑
❑ RETAININGGARAGE WALL FIRE
CARPORT ❑ ROCKERY ❑ FIRE ALARM
LER
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
uNUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
3 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HE SQU E GLAZING % LOT SLOPE %
PLANdHECK NO: 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: 180 DAYS
PERMIT LIMIT. 1 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 INDIRECI LY
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 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 STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE IOWNfER'044ZE!14fi' , / •f-QFE SIC(NED % r
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PLAT NAME/SUBDIVISION NO.
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
#Awfa-' --- DATE
BE ACCEPTED
DATE
SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED ALLOWED , PROPOSED
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REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.) I
FRONT SIDE REAR FRONT L/R SIDE REAR c9
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PARKING I LOT AREA PLANNING REVIEWED BY DATE g
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE OF
OCCUPANT n
GROUP //��'
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
❑ YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
VALUATION
Description
FEE Description FEE
State Surcharge
City Surcharge
30
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Plan Chk. Deposit
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Receipt N
Total Amt. Due
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Receipt # 47-1�-
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FICIALS SIGNATUR DA E
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ATTENTION Zj % ?C> > z 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
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN -ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS
FOUNDATION:
Footing .............:........
Watl ..................
Pier/Porch
1
Retaining Wall
Slab Insulation
PLUMBING:
Underground .............
Rough -In
Commercial Final ... .
HEATING:
Gas Test
Gas Piping
Equipment
Commercial Final .......
EXTERIOR SHEATHING
NAILING
FRAMING
FIRST FLOOR FRAMING...
INSULATION
Floor Insulation
Wall Insulation
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR r f7 n J
OCCUPANCY UV
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