20040058.pdfU
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
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NAME
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ZIP TELEPHONE
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ZIP I TELEPHONE
ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER E
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL
ADDITION COMMERCIAL
El REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTI[VITY) KXPLAIN:
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NUMBER
NUMBER OF
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STORIES :2
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DESCRIBE WORK TO BE DONE
CEIL #
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DATE CHECKED(
11 PLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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USE
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PERMIT EXPIRES -
PERMIT
NUMBER
9
JOB SUITE/APT#
ADDRESS
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $7
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T E 7SCP A proved [237
PUBLIC RIG14T OF WAY PER OFFICIAL STREET MAP
RW Permit Required
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S!reel Lisa Point Heit'd
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EXISTING PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Undaiground
Witing required
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METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES 0 NO 13
REMARKS
OWN ER!CON TRACTOR RESPONSIBLE FOR EROSION CONTROL,1DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED
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EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
L/R SIDE HEAR
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PARKING
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PLANNING REVIEWED
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DATE
REO'D I PROVIDED
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REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION JAREA
REQUIRED [] `1
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OCCUPANT
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 18
M
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
H _T
EAT SOURC� GLAZING 9% LOT SLOPE % Building Permit City Surcharge
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT C FIS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
cc Engr. Review
Uj PERMIT APPLICATION: 180 DAYS ----------
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.-
ml Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIM THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until Signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CgPE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space Provided.
WORKMEN'S COYPENSATIO�4WSURffE AND 11CW 18,27.
OFFICIALS SIGNATURE DATE
SIGNATURE DATE SIGNED (425)
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771-0220 rREL5Aj
ED BY _A1DATX'
Al I LN I 1L)N tx I I ;j j;j
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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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
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Slab Insulation ..........
PLUMBING:
Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................