20040011.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
EF�NAMEMAME� OF 13USJNESS
MAILING ADDRESS
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CITY ZIP TE EPHONE
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NAME
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CITY ZIP TELEPHONE
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ADDRESS
CITY zip V TELEP14ONE
STATE LICENSE NUMBER EXPI ATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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F)�,RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
C] DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
[TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
OF
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STORIES
NITS
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DESCRIBE WORK TO BE DONE
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PLAN CHECK NO:
GLAZING %
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USE
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JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER
UITE/APT#
71
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
2- l� REQUIRED DEDICATION- FT
I METER SIZE T LINE SIZE I NO. OF FIXTURES
VVILUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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F� OTHER
LID NO.
LID FEE S
TESCP Approved
aw Permit Required
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
Underground
Witing required
PRV REQUIRED
YES 11 NO 13
REMARKS
OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
ENGINEERI
FIRE REVIEWED BY
S' i-� fO U S T B
RVE0 BY CITY INSPECTOR
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ATFIDAVITS" SHALL V I
DATE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
I BOND
REQ'D
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POSTED
OYES D NO
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SEPA REVIEW
SIGN AREA
HEIGH
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE .3
REQ'D I PROVIDED I 1 0.
Fr) I REMARKS
FIRE SPRINKLER
FIREALARM
CHECKEDBY ITYPE FCONSTR CTI IN CaE OCCUPANT /1
CRITICAL 017, GROUP
JAREAS SPECIAL I INSPECTION JAREA OCCUPANT
NUMBER rREQU,RED [:, Yl LOAD
REMARKS 0
P p 0 1
ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
40 1) t 0 1 lne�
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: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN1. 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 1 HIS PERM11 SHAt L NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS 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 IN5URANCE AND RCW 18,27.
VALUATION
4
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
1 2: 3_4
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
= CIA[ S SIGNA RE DAT
SIGN RE (OWNERO�G �NTI., 1�__/A DATE SIGNED (425)
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4,*ENTION 2�j 7703 2JT E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPYVBUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
DA
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
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-Retaining Wall .........
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Slab Insulation ..........
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PLUMBING: --I
x
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Underground ............. C
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0
Rough -In ................... -40
0
Commercial Final ......
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HEATING: g) -1 1
C
Gas Test .................... >
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Gas Piping .................
0 -n
Equipment .................
Commercial Final ....... M M
EXTERIOR SHEATHING 055
0 r-
NAILING .......................... 0 M
C cn
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FRAMING ........................ M 0
z
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... >
z
Wall Insulation ........... M
Cn
Ceiling Insulation ....... z
0
SHEETROCK NAILING ... --I
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................