20040028.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY Z TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
CBL #
USE
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JOB
ADDRESS
[PERMIT EXPIRES
PERMIT
N U M B E R --�ZO 5Z55)
SUITE/APT#
PLAT NAME/SUBDIVISION NO. LOT NO,
LID NO.
LID FEE $
7L-5zCp—AP—p—r o—v-0 �d[3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Rw Permit ReqUiFird
street use permit Req'd
EXISTING � PROPOSED
Inspection Requited
Sidewalk Rart,jifed
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REQUIRED DEDICATION— FT
umserground
"firing rerikiirod
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METER SIZE jO, OF FIXTURES
PRV REQUIRED
YES [j NO C3
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REMARKS
RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE tu
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VARIANCE OR CU SHORELINE OR ADIIII I INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REQ'D POSTED
SEPA REVIEW SIEN AREA DYES ONO S HEIGHT
PROPERTYTAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
ul EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (R)
MNEW RESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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X AICOMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
MULTIFAMILY PARKING D LOT AREA PLANNING REVIEWED BY DATE
REMODEL SIGN REQ'D PROVIDE
GRADING FENCE
El REPAIR CYDS I — X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
zi CARPORT -ROCKERY FIRE ALARM
I[TYPE OF USE, BUSINES§,Qp ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF STRUCTIQI`j OCCUPA
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0 CRITICAL
In NUM13ER OF PECTClsi AREA
uj NUMBER DWELLING AREAS SPECIAL INS OCCUPANT
0 OF LOAD
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0 YES
DESCRIBE WORK TO 13E DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 6
5
M
VALUATION
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
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: 180DAYS
W
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit I
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE,
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 #
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 Landscape Insp. TotalAmt. Due
0 DEEMED TO MODIFY, 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 APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building 011icial of his/her Deputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided,
WORKMEN'S �=ATION INSURANrE AND RCW 18.27. OF SIGNWATqQR DATE
I DATE SIGNED (425) 1
SIGNATURE C:WNER /0 AGENT) 1. b-h+41 -
1,72� . C, � -0220 RELEASED BY DAIF�
771
ATTENTION 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 - INSPECTOR
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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