20040116.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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STATE LICENSE NUMBER
11 NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, -I
RESIDENTIAL
COMMERCIAL
El MULTIFAMILY
GRADING CYDS
TANK
RETAININGWALL
ROCKERY
17A
DATE I CHECKED BY
1:1 PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
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FIRE SPRINKLER
FIRE ALARM
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PERMIT EXPIRES
PERMIT
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NUMBER
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ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO
PUBLIC 111GIII OF WAY PER OFFICIAL STREET MAI)
EXISTING - PROPOSED
REQUIRED DEDICATION- Fr
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
Rw Permit Required
Street use Permit Roq'd
lospoction floquaird
Sidewalk Required
Underground
Winng;oquirod
PRV REQUIRED
YES 13 NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
RING REVI
FIRE REVIEWED BY
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DATE
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ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
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FRONT URSIDE REAR
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Description FEE
Description FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City SUrchargel
PLAN CUCK NO- VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2
Engr. Review
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Uj PERMIT APPLICATION: 160DAYS
ILI PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 1BO DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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Fire Review
Plan Chk. Deposit
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS. IkASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt llil
ALL CLAIMS FOR DAMAGES OF WHAT EVER NAIURE, ARISING DIRECTLYOR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1111S PERMH SHAIA NOT 13E
REDUCE ANY REQUIREMENT
Landscape Insp.
Total Amt. Due AW
DEEMED TO MODIFY, WAIVE OR OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS A131LIlY 10 ENFORCE ANY ORDINANCE PROVISION"
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Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ 1111S APPLICATION, THAT THE INFORMATION
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APPLICATION APPROVAI
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
GLEN
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
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CALL
I hisapplicalion is not a pernut until signed by tho
TION. AND IN DOING THE WORK ALIT) IORIZED ri LIEREDY. NO PERSON WILL BE EMPLOYED
T ION - '
Building
Olficial oi his/hor Deputy and Fees are paid, and
IN VIOLATION OF THE LABOR-CDDE OF THE STATE OF WASHINGTON RELATING TO
I N V 10
FOR INSPECTIO14
receipt is acknowledged in Space provided
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OFFICIAl S SIGNATURE DATE
SIGNATUR DATE STNED
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ATTENfION'
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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 - NSPEC OR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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PINK - OWNER GOLD - ASSESSOR
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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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