20040018.pdfM
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
5 R NAME/NAME OF BUSINESS
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CITY ZIP
NAME
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NAME
, N - va
ADDRESS
ZIP
99�
TELEPIIONE
LIJ-5717
TELEPHONE
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CITY zip ONE
7D
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STATF I 1173:1,142C kit lklmcn EXPIRATION DATE CHECKED
-7
PROPERTY TAX ACCOUNT PARCEL NO.
C cy�
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NEW RESIDENTIAL
ff�PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
F� CHANGE OF USE
E] REMODEL MULTIFAMILY SIGN
GRADING FENCE
11 REPAIR El Cyns ( x FT)
DEMOLISH F-1 TANK F� OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 13 ROCKERY 1:1 FIRE ALARM
USE
ZONE
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO
--1 -1. ()V
PERMIT EXPIRES
PERMIT
NUMBER
SUITEIAPT#
L D NO.
'ID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE F NO. OF FIXTURES
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION
00SERNtO By MITTS
ENGINEERING REVIEWED
FIRE REVIEWED BY
TLSCP Approved
13
HW Permit Finquired
[3
Street Use Permit Rari'd
13
Inspactirin floquiled
13
Sidewalk Required
13
underground
Wiring required
0
PRV REQUIRED
0
YES 0 NO
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L/DRAINAGE
3
DATE
DATE uj
VARIANCE OR CU HORELINE OR ADBI I INSPECTION I BOND
REQ'D POSTED
YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE 0.
REO'D I PROVIDED I I
REMARKS
(TYPE OF USE, 13USINESS Q ACTIVITY) EXPLAIN: CHECKED BY I TYPE OrGOj7jT OCCUPANT
GROUP
w NUMBER NUMBER OF CRITICAL
OF -2- DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
NITS NUMBER LOAD
to STORIES REQUIRED [] YE
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD__ i]
COO R y i T'�/xd, , iloalvij
etu 00 00 VALUATION
$
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
V)
Fire Review
Plan Chk. Deposit
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt
ALL CLAIMS FOR DAMAGES OF WHAT EVER NATURE, ARISING DIRECTLy OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT BE
LandscapeInsp.
Total Amt. Due
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"
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Recording Fee
Receipt 9
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT; AND TFLAT I AM TliE OWNER, OR TIIE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a perinit until signed by thL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building
Official or his/her Dcpuly� and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
(Lceipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
06�CIAI_ SIGNAFUR DATE
SIGNAT� A�WNER I AGENT) DATE ;3IGNED
(425)
I/ �/2=61 �'
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771-0220
a �m
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ASFD BY DATE
AfTENTION
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-
ORIGINAL FILE YELLOW - INSPEC I Oil
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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 .......
---
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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