20040065.pdfI
DATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME,.qF BUSINE�S
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MAILING ADDRESS
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CITY IELEPHONE
ZIP 921-771
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NAME
ADDRESS
CITY
NAME
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ADDRESS
ZIP I TELEPHONE
405
19M
CBL 4
2
PERMIT EXPIRES
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USE PERMIT
ZONE NUMBER
JOB SUITE/APT #
ADDRESS L/"*k
PLAT NAME/SUBDIVISION NO. I LOT NO. I LID NO
PUBLII nIGHT OF WAY PER OFFICIA.�S�i,,R Prnf
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STATE LICENSE NUMBER EXPIRATION DATE I nCHECKED dB
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
krRESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
El
REPAIR
GRADING
CYDS
1:1
FENCE
( X FT
DEMOLISH
1:1
TANK
OTHER
GARAGE
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RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
= r (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF
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NUMBER OF
DWELLING
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CRITICAL
AREAS
o STORIES
UNITS
NUMBER
DESCRIBE WORIIrTO BE DONE
9
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PLAA CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
U)
ui
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIYOR INDIREC11Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
C1
A DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITYTO ENFORCE ANY ORDINANCE PROVISION.-
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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 ViCiLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT00--l'N'SOBANCE AND RCW 18 27.
S�K (OWNER ?kLG �NT,/ DATE JSIGNED
Regardless of whether the water system
FIRE RE tME10POn or closed, expansion tankSAWO
cc
irequired on all hot water tanks per rL
F Y U N
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
,
L_
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REMARKS
CHECKED BY ITYPE OF
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SPECIAL INSPECTION JAR -EA I f OCCUPANT
REQUIRED YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
M
VALUATION
Description
FEE
Description
FEE
&n Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
N,
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
.............
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
11 7 - �51 i
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAI I
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OF CIA[ SIGNATU WDATE
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ff_sF*D BY D T
A17ENTION 61 E)ff 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
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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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: 4-
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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