20040042.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP LEPH. NE
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NAME
ADDRESS
CITY ZIP ]TELEPHONE
NAME CBLN
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PERMIT EXPIRES
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PERMIT
NUMBER
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ADDRESS
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PLAT NAME/SUBDIVISION NO.
LID NO.
LID FEE $
TESCP Approved
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PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
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AW I'annit Required
Street Use Permit Roq'd
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XISTING — PROPOSED
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inspection Required
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Underground
Wiring required
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METER SIZE
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NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER �EXPIRATION DATE _9KJECKED 9Y
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL El PLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING FENCE
CYDS ( x F-T)
DEMOLISH TANK OTHER
:GARAGE RETAINING WALL Ei FIRE SPRINKLER
I CARPORT El ROCKERY FIREALARM
(TYPE OF USE.�USINESS OR PCT[VITY) EXPLAIN:
1 NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
UNITS NUMBER
STORIES
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK 7: 4,-. VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tz BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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W PERMIT APPLICATION: 1130 DAYS
PERMIT LIMIT.* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC FLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
_j 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.4
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
SIGNATURE OR (GENT) DATE SIGNED
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
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SHORELINE OR ADB#
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REQ'D
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SEPA REVIEW
SIGN AREA
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EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSE
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LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRO SIDE REAR FRONT
L/R SIDE REAR
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CHECKEd'BY TYPE OF CONSTRUCTION Cl E OCCUPANT
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REQUIRED [—] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D 5
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VALUATION
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Description
FEE
Description
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FEE
Plan Check
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State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt III
17,
4,,-
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building 011icial or hisiher Deputy: and Fees aie paid, and
FOR INSPECTION
receipt is acknowledged in space provided. —
OFFICIA1 S SIGNATURE DATE
(425)
771-0220 'f
RFI FA�L-P'BY DATE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
'INAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
E OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PRESS HARD -YOU ARE MAKING 5 COPIES
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ORIGINAL - FILE YELLOW -'INSPI�CTOF
PINK - t)WNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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SEtBACKS:
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APPROVED BY PLANNING
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Lee Resldence
8001 Tatbot Rd.
Edmonds, Wa. 98026
Scatel 1'=30'
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R E: C, E I V E D
DEC 9 2003
PERMIT COUNTER
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DEC - 92
PERMrT COt
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RECEIVED
SEP - 9 2003
DEVELOPMENT SERVICES CTR.
t-- ----CITY OFEDMONDS
MICROFILM STREET FILE
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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:
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 ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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