20040023.pdfDATE RECEIVED
[PERMIT EXPIRE
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USE PERMIT A
CITY OF EDMONDS ZONE NUMBER '�)rcic__L
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
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OWNER NAME/NAME OF BUSINESS
4. PLAT NAMEISUBDIVISION NO LOT NO. LID NO
LID FEE
UM MAILING ADDRESS I
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R: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PoFM11 H-10ki-MIJ 0
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CITY ZIP TELEPHONE EXISTING - PROPOSED Inspect,nn Requ" "d 0
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REQUIRED DEDICATION- FT
NAME lie 7 7el' METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
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U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
CITY ZIP TELEPHONE
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ENGINEERING REVI
DATE
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FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE
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VARIANCE OR CU SHORELINE OR AD1111 I INSPECTION BOND
STATE LICENSE NUMBER EXPIRtAT)ON ATE CHEC BY REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARC;7NO. COMPLETE , EXEM13T ALLOWED PROPOSED ALLOWED , PROPOSED
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1:1 NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR z
1:1 ADDITION COMMERCIAL 2
El CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
ULREPAIR GRADING FENCE I I
CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
�:E r (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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'0 REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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Description FEE Description FEE
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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
t3 IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 9
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS 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- I his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL 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 18.27.
FIE IGNAFRE DATE
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1;7 C
SIGNATURE'(OWNE OR��AGE DATE SIGNED (425)
it.- C)
771-0220 �R AS BY DATE
ATTtNTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL v LLL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- R GINAL - FILE YELLOA INSP TO,
0 1
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 4 COPI) '
PRESS HARD -YOU ARE MAKING S
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ........... 0
Slab Insulation ..........
ITI
PLUMBING:
Underground ............. n
Rough -in ................... 0 IT!
C
M
0
Commercial Final ......
0
0
C
HEATING:
M
M Z
GasTest .................... JO --i
C
Gas Piping ................. >
3:
Equipment .................
Cn
0 -n
Commercial Final ....... -n
EXTERIOR SHEATHING 3:9
NAILING .......................... M ITI
0
0
FRAMING ........................ 0 M
C (D
Cn
FIRST FLOOR FRAMING ...
Q 0
Z r
INSULATION ................... 7-1
Floor Insulation .........
:C
Wall Insulation ........... >
z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
--I
SPECIAL INSPECTION ...
171
&ISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
000