20040067.pdfI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRA
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PROPERTY TAX ACCOUNT PAIJCEL NO.
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REPAIR
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CYDS
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CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
PIPP At AAKA
(TYPE OF USE. BUSINESS OR ACIlVtM EXPLAIN
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NUMBER NUMBER OF
OF DWELLING
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0 STORIES UNITS
DESCRIBE WORK TO BE DONE
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CRITICAL
AREAS
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GLAZING %
LOT SLOPE %
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.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, IFSOFFICIAIS, EMPLOYEES, AND AGENTS FROM ANYAND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC FLY OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC '
1ION; 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 COMPEN5ATION INSURANCE AND RCW 18 27.
SIGNkVURE (OWN_ERb9_NGEAIT) _.) — I I DATE SIGNED
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PERMIT EXPIRES
USE PERMIT
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ADDRESS 1010
PLAT NAMEISUBDIVISION NO LOT NO LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STR
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FIRE REVIEWED BY
LID FEE $
TESCP Apptaved
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W'Iffoctrad 13
PRIREQUIRED
YES NO 13
EROSION CON1ROL/DRAINAGE
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DATE
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VARIANCE OR CU HORELINE OR ADBI I INSPECTION I BOND
REO'D I POSTED
E]YES ONO IS
SEPA REVIEW SIGN AREA HE16HT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ'D I PROVIDED I I
REMARKS
CHECKED BY I TYPE 1�� I ft I OCCUPAN r
SPECIAL INSPECTION JAREA
REQUIRED [] YES
REMARKS a
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D I a
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
1-5
Plumbing
Base Fee
_2
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt N
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
.7
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
I his application is not a permit until signed by itie
Building Official or his/lier Deputy: and Foes are paid, and
receipt is acknowledged in space provided
V,
14
1f(jtrASFD BY
ATTENTION 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
OHIGINAL FILE YELLOW -INSPECTOR
PINK OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
-SETBACKS
FOUN'DAT*ION:,.....,
ooting-
'W .. ........ ............
al
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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