20040092.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
JWNER NAME/NAME OF BUSINESS
MAILING
ADDRESS
CITY
I PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
ZIP ELEPHONE EXISTING - PROPOSED
IT REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
ZIP I TELEPHONE
SUITE/APTf_j
LID NO.
LID FEE S
TESCP Approved
PW Permit Required
Street Use permit Req'd
inspection nequired
Sidewalk Required
Underground
Wiring required
PRV REQUIRED
YES IJ NO 13
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME CqL#
Ad ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE Lu
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ZIP 7 VARIANCE OR CU SHORELINE OR ADBP INSPECTION BOND
STATE LICE ISE NUMBER )N DATE CHECK BY REO'D POSTED
Ir ki � [�/etc piiz-� I D SEPA REVIEW SIGN AREA 111YES ONO $ HEIGHT
PR9kERTYTAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
0 L 7 D
10 A U EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR
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ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DAT
REMODEL MULTIFAMILY E] SIGN REQ'D PROVIDED
GRADING o FENCE
REPAIR r y no ( X FT) REMARKS
DEMOLISH TANK ED OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
l CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS R ACTIV 11 nPLAIN:
rz CHECKED BY TYPE 0 N OCCUPANT
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GROUP
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uj NUMBER UMBER OF CRITICAL
'3 OF rDWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
M U LOAD
01 STORIES UNITS NUMBER REQUIRED [3 YES
DESCRIBE WORK TO BE DONE 0
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D a
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VALUATION
C $
Description FEE Description FEE
Plan Check State Surcharge
HIE I
ly GLAZING % LOT SLOPE % Building Permit City Surcharge
Lit)
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
uj PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Q Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE /P lit)
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt If
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
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- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space providep
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27, 0 IC S SIGNATU TE
NED
INATURE (425)
VNER G I N DATE SIG
--.m 771-0220 ac' ItASED 13Y DAtE
ATTENTION EXT 1333 u
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04j02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
—1
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
CD
Underground ............. M
M 0
Rough -in ...................
0
0
Commercial Final ......
M
M z
HEATING: ID
_Z
Gas Test .................... >
r
Gas Piping .................
-n
0
Equipment ................. n
Commercial Final .......
M M
EXTERIOR SHEATHING Cn
0 r—
NAILING .......................... 0 M
C (1)
FRAMING ........................ K Cn
Q 0
FIRST FLOOR FRAMING... Z
INSULATION ...................
Floor Insulation ......... >
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Wall Insulation ........... __4
M
Ceiling Insulation ....... Cn
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0
SHEETROCK NAILING ... I
0
SPECIAL INSPECTION ... 1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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