20040025.pdf8
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMErIME OF BUSINESS
MAILING ADDRESS
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NAME
NAME
ADDRESS
ZIP TELEPHONE
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ZIP
TELEPHONE
USE
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JOB
ADDRESS
PLAT NAMEISUBDiVISION
PERMIT EXPIRES
PERMIT
N U M B E R
LOT NO.
I
_0101
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRE[) DEOICAIION� Ff
METER SIZE LINE SIZE NO. OF FIXTURES
sLjiTE/APT#
LID NO
LID FEE $
T-F,SCP Approved
R�; polmil goq1n,ad
street use penn't Roq,d
inspection ROVil"d
Sidowall, ROV'red
Undelground
Winngfo(ltflr0d�
PFIV REQUIRED
YES [3 NO C3
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL 4
�A�r
_� JC_ ENGINEERING LREVIEWE�Dllly
CITY'_� ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRAT . [ON DAIL dc;HECKED JB
C11
PROPERTY TAX ACCOUNT PARCEL NO.
.4d I
NEW
0
RESIDENTIAL
PLUMBING I MECH
ADDITION
11
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
MODEL
n
MULTIFAMILY
SIGN
n
REPAIR
1:1
GRADING CYDS
FENCE
( � X FT)
DEMOLISH
13
TANK
OTHER
GARAGE
13
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
CARPORT
(TYPE OF USE,
BUSINESS OR ACTIVITY) EXPLAIN:
R
NUMBER OF CRITICAL
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
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 LIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 OFINHATEVER NAT URE, ARISING DIREC fly OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE Or THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENI 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 AUTIIORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
I [ON; AND IN DOING 11 iE WORK AUTI IORIZED TI IEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S Cq�PENSATION INSURA E AND RCW IB 27.
—1 DA ED
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FIRE REVIEWED BY
DATE
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VARIANCEon cu
SHORELINE OR ADB# INSPECTION BOND
POSTED
REQ'D
OYES ONO S
SEPA REVIEW
E X EMPT
CUMPLk: I t: EXEMPT
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
Al
EXP I - —
— LOT COVERAGE
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
REAR
ALLOWED PROPOSED
FRONT SIDE REAR FRONT LJR SIDE
(3
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PARKING
LOT AREA I PLANNING REVIEWED BY DAT E
REQ'D
unheated
CHECKED 13Y ITYPE
UMC 815.1.7
OCCUPANT
GROUP
OCCUPANT
SPECIAL INSPECTION' AREA LOAD
REQUIRED [] YES I
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
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4�1
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description
FEE
State Surcharge
City Surcharge
1,4�)
Base Fee
6
CALL
FOR INSPECTION
(425)
771-0220
"T 1 0111-01
Plan Chk. Deposit
Receipt It
Total Amt. Due (�2,t)
Receipt #
APPLICATION APPROVAL
I his application is not a permit tintil signed by the
jing otticial or his/her Deptity: and Fees aw paid. and
)i receipt is acknowledged in space provided.
I
IALS sirm�rURE DATE
A.,Fn lY TE
ATTENTION TRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR S
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGiNAL-FILE YELLa'V.INSPEC70R
PINK -OWNER GOLD -ASSESSOR
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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:
15
�tqas%, es
Gas Pipirig .. ........... ......
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 C
OCCUPANCY ..................
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