20040129.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATIO
OWNER NAME/NAME OF BUSINESS __
MAILING ADDRESS
4,
CITY
NAME
ADDRESS
CITY
NAME
_. V.- L P1
ADDRESS
ZIP TELEPHONE
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ZIP I TELEPHONE
ZIPV_ I TELEPHONE
5IA3E LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO,
NEW
E�_11�SIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR-ACTMTYIjE2PLAIN
NUMBER NUMBER OF
OF 1-7, 1 DWELLING
STORIES
j� __ UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
CBL #
IDATE
6 h
117
C;j-FCGMBING / MECH
ECOMPLIANCE
OR
CHANGE OF USE
SIGN
FENCE
( — X_
El
OTHER
FIRE SPRINKLER
FIREALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
4` V
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
j
6 2;
PERMIT EXPIRES
PERMIT
NUMBER
7 SUITE/APT#
t
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Required 13
EXISTING - PROPOSED
Street Use Permit Roct'd Q
inspection Required 13
Sido"Ik ReqUited 0
REQUIRED DEDICATION. FT
I Underotound
I Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
0
YES CI NO Z
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OWNER/CONTR ACTOR RESPONSIBLE FOR EROSION CONTFIOL/DRAINAGE z
REMARKS
ENGINEERING
DATE
FIRE REVIEWED BY
DATE
W
VARIANCE OR CU
SHOREIINEORAD1111
BOND
REO'D
I.INSPECTION
POSTED
YES
ONO
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
I
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REQ'D I PROVIDED I I CL
FT) I REMARKS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1130 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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, %��SHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF rHis PERMI r. ISSUANCE OF THIS PERMIT SHAI I NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY I HE 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 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING THE WORK AUT14ORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATXW!N�IURANCE AND iRCW 18,27
SIGNATURE (OWNER, 09 AGENT) DATE SIGNED
%
CHECKED 13Y JTYPE,1,11F��O UC-FION CODT,, OCCUPANT
GROUP A
NT
SPECIAL INSPECT11071 REA OCCUPANT
2S LOAD
REQUIRED [] Es
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D
VALUATION
FEE
LI 0 0
Description
State Surcharge
City Surcharge
�Base-Fee -
0
'7
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 in space provided.
OFFICIALS SIGNATURE DATE
RELEASED,8Y DATE
ATTENTION 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-
0131GINAL - FILE, YELLOW. IqSPECM� R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -i`OVVNEH-� GOLD I ASSESSOR
09,103 PRESS HARD -YOU ARE MAKING 4 COPIES
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
V�s
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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