20040071.pdfDATE RECEIVED
_I PERMIT EXPIRES ILL
70NE PERMIT
ONDS NUMBER
CITY OF EDM USE
CONSTRUCTION PERMIT APPLICATION JOB RESS7C/Z suiTE!APT#
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OWNER NAME/NAMItF BUSINESS
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PLAT NAME/SUDDIVISION NO FP LOT NO LID NO
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ADDRESS
CITY ZIP I TELEPHONE
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STATE LICENSE NUMBER EXPIRATI N DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
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RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINE_a§ OR ACTIVITY) EXPLAIN:
w NUMBER NUMBER OF
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DESCRIBE WORK TO BE DONE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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SOURCE I GLAZING % I LOT SLOPE %
PLAfi 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.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
wAPPLICANT, 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, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABIL11Y 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 DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC-
TION; 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 COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURV(OWNER %AGE�V DATI SLrNED
REMARKS
OWNER/CONTRACTOR RESPONSIBLE
water system
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FIRE REVIEWED BY DATE
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ALLOWED. ROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKRSEA(FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SID E R
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
CHECKED BY ITYPE OF-r-ONITRUCTION OCCUPANT E?
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [- LOAD
YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
$ L
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
77 Base Fee
CALL
FOR INSPECTION
(425)
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/lier Deputy: and Fees are paid, and
receipt is acknowledged in space provided. I
7flCIAI,,� SIGNATun0 DATE
ATTENTION 0 Wk I I
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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:D BY DATE
ORIGINAL - FILE YELLOVV - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall............... : .......
z
Pier/Porch .................
Retainlng Wall ........... 0
ITI
Slab Insulation ..........
PLUMBING:
Underground ............. M
C
M 0
0
Rough -In ...................
0 C:
Commercial Final ...... K
M
M Z
HEATING:
C
Gas Test .................... >
Gas Piping .................
Equipment .................
Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
C CD
9 CD
FRAMING ........................ M 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
>
Floor Insulation .........
z
--I
Wall Insulation ...........
Ceiling Insulation ....... z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ... ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Z004.o, 60 7/