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CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
NUMBERL9
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ADDRESS SUITE/APT#
OWNER NAMEMAME OF BUSINESS
20412 80th Ave W
Arthur Haslam
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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MAILING ADDRESS
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20412 80th Ave W
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 13
RW Permit Required E3
EXISTING Street Use Permit Aoq'd E3
CITY ZIP TELEPHONE
Edmonds 98026 425-774-0972
PROPOSED Inspection Required E3
sidewalk Required E3
REQUIRED
DEDICATION— FT Underground
NAME
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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Ci� Code. ECDC 19-30.020
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Fast Water Heater
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DATE
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ADDRESS
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12601 132 Ave NE
FIRE RE� DAIF
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CITY ZIP
TELEPHONE
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Kirkland 9=8034
425-814-3124
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STATE LICENSE NUMBER EXPIRATION DATE
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ED NEW RESIDENTIAL PLUMBING / MECH
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LOT COVERAGE
ALLOWED
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
-4 2W ADDITION COMMERCIAL COMPLIANCE OR
PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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CHANGE OF USE
REMODEL MULTIFAMILY
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PLANNING REVIEWED BY DATE
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GRADING FENCE
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REMARKS
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DEMOLISH TANK 1:3 OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
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FIRE ALARM
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REMARKS
PROGRESS INSPECTIONS PER UBCwa/FINAL INSPECTION REQ'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
0
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Grading
SEPARATE PERMISSION.
2
Engr. Review
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PERMIT APPLICATION: 180DAYS
PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
.......................
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS I HE CITY OF
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2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, ARISING DIRECTLY OR INDIRECTLY
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Fire Inspection
Receipt #
:C FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMP SHALL N01 BE
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Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
A�FPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATINGCOKICTO"
U. I his application is not a Permit until Signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON Building Official or his/her Deputy: arid Fees are Paid. arid
RELATING TO FOR INSPECTION receipt is acknowledged inspac, p
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. u r vided.
SIGNATURE (OWN OR GEN OFFI I-S SIGNAI RE DATE
DATE SIGNED (425)
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771-0220 �hE EASFD BY
ATTENTION EXT 1333 DA
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE TI Fl-
CATE OF OCCUPANCY HAS BEEN GRANTED. U13C SECTION 109 ORIGINAL -FILE YELLOW- INSPECTOR
PINK OWNER GOLD -ASSESSOR
09/03
PRESS HARD -YOU ARE MAKING 4 PIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....
FOUNDATION:
Footing ......................
Wall..........................
...,...,Pier/Porch .................
'Aetalhihg Mir ............
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Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
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FINAL APPROVAL FOR
OCCUPANCY ..................
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