20040068.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE I ICENSE NUMBER
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PROPERTY TAX ACCOUNT
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ADDITION
REMODEL
REPAIR
DEMOLISH
oGARAGE
CARPORT
(TYPE OF USE. I
17
EXPIRATION DATE
9/7 Ir"(1.
P CEL NO,
0 (3 kcr)j
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAIN
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PLUMBING / MECH
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SIGN
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OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USF PERMIT
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NUMBER
J JOB SUITE/APT#
0 3
FADS3 D RISS 147
MAT NAME/SUBDIVISION LOT NO LID NO.
LID FEE $
IF SCIP Aprilmed 0
Rw Pi,mil Required 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Street Use Purout Req'd 13
EXISTING — PROPOSED
inspection Requited 13
S'aewali, Required 13
REQUIRED DEDICATION— F-I
undwilround
Wiring required E3
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES 0 NO 1:1
RFMARKS
OWNFR,,CONIHA,;IOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVI
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU HORELINEORADB# JIN CTION I BOND
REO D POSTED
YES ONO s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA _175���WED BY DATE 5
REO'D I PROVIDED 0.
REMARKS
CHECKED BY I TYPE ( F CONST�UCT N Coql� OCCLIPANTJI_-�
GROUP I
Ll NUM13ER NUMBER OF CRITICAL
0 F DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
STORIES UNITS NUMBER REQUIRED [:] YES LOAD
DESCRIBE W6AK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ'D
VALUATION
$ .
Description FEE Description FEE
Plan Check State Surcharge
'OUJE GLfZINGJ% LOT SLOPE % Building Permit City Surcharge
PLAI'l CHEdK NO: VESTED DATE Plumbing Base Fee
Mechanical 1.7 ICIN
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 Grading
SEPARATE PERMISSION.
Engr. Review
a: PERMIT APPLICATION: 100 DAYS
W
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in *APPI ICANI, ON BEHAi F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOBS Fire Review Plan Chk. Deposit
in
UJI IN INIFFIFS1, AGRFES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS rIIF CITY OF
_j
I EDMONDS. WASHINGTON, ITS OFFICIALS. FMPiOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 9
Ir
d At I CLAIMS FOR DAMAGES OF WIIAIFVER NATURE. ARISING DIHECfIY Oil INDIRFCIIY
x FROM IliF ISSUANGE OF IIIIS PFHMII. ISSUANCE OF 1111S PFHMIl SIIAII NOT BF 17 qr—
C3 DFrMFj) 10 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR I IMIT IN ANY WAY THE CIFYS AUIiIIY 10 ENFORCE ANY ORDINANCE PROVISION
X
Recording Fee Receipt 0
1 1 J_
I IIEREBY ACKNOWiEDGE IIIAT I IIAVE READ THIS APPLICATION, THAI THE INFORMATION
GIVEN 1,1; CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZFD AGENT 017 APPLICATION APPROVAL
Iijr. OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIRLJC I Ills application is 1101 it pefflull until signed by the
LION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON Wit I BF ENVILOYrD CALL Building 011icial or his/tier Deputy and Fees are paid, and
IN VIOLATION Of THE LABOR CODE OF THE STATE OF WASiIINGTON RELATING To FOR INSPECTION iLceipt is acknowledged in space provided
WORKMENS COMPEN URANCE AND FICW 111 27
I UIIF I IF
,4EF ( I A 'ENT DA
SIGNA JHE (OW1:1 &11 A KFNI (425)
DAT
771-0220
AfTENTION zJIF EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPI30VAL Oil A CERTIFI- 0111GINAL FILE - YELLOW - INSPLCTOIJ
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK OWNER - GOLD ASSESS01i
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 .................
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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