20040074.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
R NAME/NAME OF BUSINZ,
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M�ILING ADDRESS
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NAME
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NAME CBL#
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CITY TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
LI) 0 (� 60 0 6
NEW ARESIDENTIAL 'XPLUMBING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK OTHER
oGARAGE E:i RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINES!j_QR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES I UNITS, I NUMBER
DESCRIBE WORK TO BE DONVI /I ry JA -V 1 74, 1
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HEAT SOURCE I GLAZING 1% 1 LOT SLOPE %
PLAN 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: 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, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS 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 DULY AUTHORIZED AGENT OF
THE OWNER. I AGRLE TO COMPLY WITH 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 COMPENSATIQUINSURANCE AND RCW 18.27.
DATE
I I/
USE
ZONE
JOB
ADORES
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT -7,
NUMBER-
suiTE/AP I fir
LOT NO LID NO
LLID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW pormll Required [3
Stine, Ilse porerrit Hoq'd [3
IQ&Qfi4 on Required Q
Sido*ilk Requited [3
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LPirgitacimrod
JTCCEIale Tertftjt4ro 'a _ 13
jjab&1L1Zj , llifflaftHV RV REQUIRED
fS C3 0 1
NY"E' 0 NO 13
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED
lv4ater system
Fn-55R-s are
DC 19.30.020 (c)
PIPE TEST MUST BE DATE
VARIANCE OR CU-44.— ONO
UAVI ifft §Tf A JS R 11V4k(4W [I B
, UVERMO S POSTED
SEPA REVIEW HEIGHT
COMPLETE EXEMPT ALLOVID ALLOWED PROPOSED
JE XP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE
� NT6aMf REAR
=20T474IM11M.111M
CHECKED BY ITYPE
SPECIAL INSPECTION JAREA
REQUIRED [] YE
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OCCUPANT
GROUP
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
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VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771 -022
FEE Description
State Surcharge
City Surcharge
0 Base Fee
FEE
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
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APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provid
71 A
.SIALS SIGNATURE
FLEASED BY
DA
ATTENTION E)ff 1333 '
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL r
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
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INSPECTOR DATE APPROVED
1,4
3ETBACKS
FbUNDrATION*
Footihg .....
P
Wall
4
Slab Insulation .....
PLUMBING:
Underground
1
Rough4q
commercial Final -9#10ol
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
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MISCELLANEOUS 011,11111,
FINAL APPROVAL FOR
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