20040043.pdfDATE RECEIVED '
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NVE/NAME OF BLISI�NE SS II
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CITY �_ ZIP TELEPHONE
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NAME
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKE BY
¢ PROPERTY TAX ACCOUNT PARCEL NO.
❑ NEW RESIDENTIAL PCOMPLIANCE OR
LUMBING / MECH
❑ ADDITION ❑� COMMERCIAL
❑ CHANGE OF USE
REMODEL ❑ MULTIFAMILY ❑ SIGN
/T FENCE
GRADING
❑ REPAIR ❑ CYDS ❑ ( X FT)
❑ DEMOLISH ❑ TANK ❑ OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z ❑ CARPORT ❑ ROCKERY ❑ FIRE ALARM
O (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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oNUMBER NUMBER OF CRITICAL
OF I DWELLING AREAS
O STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: / I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
¢ PERMIT APPLICATION: 160 DAYS
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a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
w •APPLICANI, ON BEHALF OF HIS OR HER SPOUSE., HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
¢ a ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT DE
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
P NOR LIMIT IN ANY WAY THE CITY'S ARILIIY TO ENFORCE ANY ORDINANCE PROVISION
' PERMIT EXPIRES ^� U
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PERMIT
NUMBER
SUIT iFIA a
c� �l%�, b\tE/SUBDIVISION NO 1 l• NO. LIDNO.LID FEE S
TESCP Approved ❑HT OF WAY PER OFFICIAL STREET MAP RW Permit Roqunnd ❑Street use Pormit Placid ❑PROPOSED Inspection Required ❑
Sidewalk Required ❑ DEDICATION FT Underground
WrnngmquiradE I LINE SIZE NO. OF FIXTURES PRV REQUIRED t7
YES ❑ NO ❑ z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEEIING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
AM
1. MC 3150107
DATE W
LL
SHORELINE OR ADBa INSPECTION BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR O
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LOT AREA PLANNING REVIEWED BY DATE g
CHECKED BY TYPE OF CONST UCT ON CODE OCCUPANT 1
GROUP J
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED ❑ YES LOAD
REMARKS PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D o
VAL-U-AyyTION
$ C; GO e6 r
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt N
Total An1t. Due
Receipt H
I HEREBY ACKNOWLEDGE TIIAT I HAVE READ 1111S APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH I CITY AND STATE LAWS REGULATING CONSTRUC CALL I his application is Rut a permit until signed by lire
TION; AND IN DOING THE WORK AUTHORIZED TIIEREBY, NO PERSON WILL BE EMPLOYED Building Official or hislhrr 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 INSURAf CF,AND RCW 18.27, OF CIA[ S SIGNAIUIiP I DAT
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
SIG ATUR . ( WNE OH ENTI• � DATE SIGNED (425)
771 m0220
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD =YOU ARE MAKING 4 COPIES
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ORIGINAL • FILE YELLOW INSPECTOR
PINK - OWNER GOLD • ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .......
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FOUffDATION: ;
Footing i
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 UY) .-
OCCUPANCYAP%Av% (1,004,5.1
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