20040124.pdfDATE RECEIVED I I
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PERMIT f
EXPIRES
CITY
OF EDMONDS
USE PERMIT
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NUMBER
CONSTRUCTION
PERMIT APPLICATION
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SUITE/APT#
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OWNER NAME/NAME OF BUSINESS
ADDRESS
PLAT NAMEISU13DIVNIO: T NO.
LID NO,
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MAILING ADDRESS
q2-S 2- __7 NJ
(3 �1
PUBLIC RIGHT OF WAY PER OFFICIAL
LID FEE $
TIESCIR Approved
13
STREET MAP
FnN Permit Required
13
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ZIP TELEPHONE
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EXISTING - PROPOSED
Street Use Permit Ron
inspection Required
sidewalk Required
Underground
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REQUIRED DEDICATION. FI
Witing required
NAME
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
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ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME
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ENGINEERING REVIEWED BY
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ADDRESS
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CITY
ZIP TELEPHONE
FIRE REVIEWED BY
DATE
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SE NUMBER EXPIRATION DATE CHECKED BY REOO STED
STATE LICEN VARIANCE OR CU HORELINEORADB# JINSPE BOND
YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
< PROPERTY T ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW 1,E!5ZRESIDENTIAL F1 PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
E] ADDITION COMMERCIAL
El CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED IL
GRADING FENCE
REPAIR CYDS x Fr) REMARKS
DEMOLISH TANK
WTHER�
Z Ei GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPL6JN;-)
CHECKEDBY TYPE OF CONSTRUCTIor I,. OCCUPANT
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CUL) GROUP
w NUMBER NUMBER OF CRITICAL XI/ i
0 OF DWELLIN AREAS SPECIAL INSPECTIOt4_ AREA OCCUPANT
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ct STORIES UNITS NUMBER REQUIRED [] YE LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'D
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VALUATION
77
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % ;,N
Building Permit city surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO /m
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK is STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Lf) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND Fire Review
in SUCCESORS Plan Chk. Deposit
W
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMI1 SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY C11Y ORDINANCE Landscapeinsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S A131LITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
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. This application is not a perinit Until signed by the
TION, AND IN DOING THE WORK AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deptily: 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 provided.
WORKMEN' C MPENSATION�4SURANCE AND RCW 18.27. OFFICIALS SIQNATURF DATE
SIGNATURE NE OR AGEN
(425)
DATE SIGNED
OAT
771-0220 LF,,FASED'IIY
ATTENTI N EXT 1333 -- ------- ---
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 COLD . ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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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