20040106.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/
NAME OF BUSINESS
1-1
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MAILINU ADDRESS
7-4 118 t\10rn4 Aloric 11d,,t A.&
CITY
ZIP TELE ONE
(001JR0E 805 ?sio
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CITY
ZIP
NAME
An'Too( Se&jcF
ADDRESS
2.7
CITY ZIP
KwLfiAjt*-) 7,q 0 17Z-
STATE LlUtNtit NUM13ER
AAATASC066NA/
"ROPER11TAX ACCOUNT PARCEL NO'.
NEW RESID L
19 L
RC
IN
ADDITION COMMERC
REMODEL EE] LT
REPAIR G I NAG
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GARAGE FR ETA I WALL
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(TYPE OF USE, BUSINESS, VI I Y) EXPLAIN:
NUMBE
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DESCRIBE WORK TO BE DONE
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
TELEPIIONE
TELEPHONE
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18
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USE
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OTHER
A
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RE ALARM
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 HE SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMi FSS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY Oil INDIREC TLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
1 HEREBY ACKNOWLEDGE TIIAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR TIIE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE 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 T14E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIot�J�SU_QrAWE AND RCW 18 27.
DATE
F S 16)41
I
PERMIT EXPIRES
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ZONE PERMIT
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JOB
ADDRE 5
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SUITE/APT#
PLAT NAME/SUBDIVISION NO
LOT NO.
I
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appioveo
RW Permit Required
EXISTING � PROPOSED
Street Use Permit Roq'd
Inspection Required
REOUIRED DEDICATION� FT
Siclowak Required
underground
I ''I I I
Wiring required
METER SIZE OF FIXTURES
PAV REQUIRED
REMARKS
OWNER/CONTRAClOR RESPONSIBLE FOR EROSION
CONTROL/DRAINAGE
ORCU
SEPA REVIEW
COMPLETE
EXEI
IExp Aft
RKS
REQUIRED
FRONT
ING LOT
PROVIDED
TYPE
YES
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DATE
-OWI INSPECTION B
P�OND
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HEIGHT
D PR
PROPOSED —FA�LLOWED PROPOSED
AREA
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ETBACKS (FE)
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OCCUPANT
GROUP
OCCUPANT'
LOAD
S INSPECTIONS PER UBC 108/FINAL INSPECTI�0111`4 REQ'D
VALUATION
Description_
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
Description
State Surcharge
City Surcharge
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged it, space provided.
�kIA�.S.Sl�iNAJURF
� DATE
AT3ENTION f I
MMONEWN�
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL EXT 1333
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI E
04/02
PRESS HARD -YOU ARE MAKING 5 COPIES
91
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ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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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:
GasTest ....................
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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