20040060.pdfDATE RECEIVED [PERMIT EXPIRES
USF PERMIT
CITY OF EDMONDS ZONE NUMBER,..�
JOB SUITE/AP
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/N ME OF BUSIqEN
PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
cc MAILING ADDRESS LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Req'd
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EXISTING — PROPOSED Inspection Required
CITY ZIP EPHONE Sidewalk Required E3
Underground
JTEL .. REQUIRED DEDICATION— Fr W D
1111[10 1 ring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
YES NO 13
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OWNER/CO JM6.�.TOR RESPQN$IBLE FOR EROSION CONTROL/D RAIN AGE a
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CITY ZIP -_ TELEPHONE Regardless of whether the water system
Iis open or Closed, expansion tanks are
NAME CBL N iequked on d1l hul- —vvdtt!f tanks per
0-112 a citu Pgria r-r-n DATE
ENGINEER11GIRICIVIEWED-n' E-N 19.30.020(e)
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A VARIANCE OR CU SHORELINE OR AD11ff INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION)DATE IECKED BY REO'D POSTED
0YES EINO
FH1 -'s 11 1 1 1
SEPA REVIEW MIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL No. V COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW ESIDENTIAL NGIMECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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ADDITION tCLHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE a.
REMODEL 11 MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
8-REPAIR 1:1 ryps, _X FT) REMARI Slype E' or L Vent connectors
DEMOLISH 7 TANK El OTHER reqUIM imn 101. 0111,11ing appmeasba
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GARAGE RETAINING WALL o FIRE SPRINKLER unheated 414�� U�W 8154.7
CARPORT ED ROCKERY FIRE ALARM op
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPEffZNSTFR,.1JCTION conr OCCUPANJ�,
GROUP/
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uj NUMBER NUMBER OF CRITICAL SPECIAL INSPECTION 19REA OCCUPANT
DWELLING AREAS
OF I LOAD
STORIES I I UNITS J NUMBER REQUIRE[
DESCRIBE WORK'TO BE DONE ED
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
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C. VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge -7—
HECK 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
UJI
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
in
UJI IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt III
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECITY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
_j FORCE ANY ORDINANCE PROVISION."
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO EN
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 AUT11OF31ZED AGENT OF This application is not a perinit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building ollicial or his/her Deputy: and Fees are paid, and
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR,0DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S CO/W6ENS A' DATE
'fl?OF C1 S SIGNATU E
�RANCE AND ��W 16,27.
QNED C%'
10 TURE VN 1p
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771-0220 RFLEAS DAT
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ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL _j
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 ................. z
0
Retaining Wall ........... I
Slab Insulation .......... M
PLUMBING: i -n
Underground .............
M
C
Rough -In ................... M
0 C
HEATING: M
M Z
Gas Y6'st .................... C
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Gas Piping -4
................. x
CD
Equipment ................. 0 -n
Commercial Final .......
M M
EXTERIOR SHEATHING
06)
NAILING .......................... 0 r-
0 M
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FRAMING ........................ 0)
Q 0
FIRST FLOOR FRAMING ... Z
71
INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... --I
Ceiling Insulation ....... 6
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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