20040017 (3).pdfA
DATE RECEIVED [PERMIT EXPIRES
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CITY OF EDMONDS NUMBER,4,-�MW-��6 -9/*7
JOB SUITE/APTAr
CONSTRUCTION PERMIT APPLICATION ADDRESS
PLAT NAMEISUBDIVISION NO LOT Nr/ LID NO.
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
S1172AN-1 12121; - 1/ 2
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME ICBL#
ADDRESS
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
2, W2 *3 2 -3 0102 Z�0
NEW RESIDENTIAL
ADDITION 54 COMMERCIAL
REMODEL 1:1 MULTIFAMILY
REPAIR 11 GRADING CYDS
DEMOLISH El TANK
GARAGE FIETAININGWALL
CARPORT 0 ROCKERY
(TYPE OF USE BUSINESS OR ACTIVITY) EXPLAIN:
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13
COMPLIANCE OR
OF USE
CHANGE
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FENCE
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OTHER
SPRINKLER
EiFIRE
FIRE ALARM
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES 'UNITS NUMBER
DESCRIBE WORK TO BE DONE
.1
15
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID FEE $
7ESCP Approved
RW Pernlit Required
Street Use Parrrid Ract'd
Inspection Required
Sidewalk Required
underground
Winng required
PRV REQUIRED
YES 11 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVI
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
119
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADEIII I INSPECTION BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
VALUATION VV 0 Z4 -7 -3 1
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
city Surcharge
Plumbing
Base Fee
PLAN CHECK 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
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
'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 INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
I NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
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
I
APPLICATION
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APPR
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qinnad by the
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS HEGULAIINU LjUNbI MUL;- Via
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Buildinl] Offic a or his/her 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 18.27. 1 OFFICIALS SIGNATURE DATE
SIG DATE SIGNED (425)
TU�E,(O N OR(AdEN, Cf -
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�W,( . 771-0220 RE
A17ENTION E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
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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:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SH5ETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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