20040142.pdfDATE R
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME CBL 11
ADDRESS
17 3
CITY TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED
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PROPERTY TAX ACCOUNT PARCEL NO.
.-7-70 32-6 00/ 0;�COO
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ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS I x
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS 4 NUMBER
DESCRIBE WORK TO BE DONE
15 1 1 PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO
LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
HW Permit Required
13
13
street use permit Roq'd
13
EXISTING - PROPOSED
Inspection Required
13
Sidnv�alk Required
E3
REQUIRED DEDICATION-
FT
Undergrotind
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
P EQUIRED
YE NO 13
SW
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W
FIEMARKS
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OWNEFIXONTRACTOR RESPONSIBLE
FOR EROSION CONTROL/DRAINAGE
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ILIA
ENGINEERING REVIqW�D BY ATE
112-710 rj/
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: Z� VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
UJI
CL PERL41T LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCES RS
13 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLFSS THE CITY F
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREc ri-Y
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINAI, CE
0 NOR LIMIT IN ANY WAY THE CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIC N.-
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFO ION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED A 'EN1 OF
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTFUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATIN TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
SIGNATYRE (OWN R 0 AG - DATE SIGNED/
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADB# INSPECTION BOND
REQ'D POSTED
OYES ONO IS
SIGN AREA HEIGHT
I ALLOWED . PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY D E
REO'D I PROVIDED I
REMARKS
CHECKED BY ITYPE OE CONSTRUCTION OCCUPANT
GROUP
CODE
Ax i -74'52-
SPECIAL INSPECTION JAREA -014e:, OCCUPAiTT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
VALUATION
Description
FEE
Description
F
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
�s
7F2
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
e,-,
4!�
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
I tits application is not a perinit until signed by the
Building Official or tits/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFIC�IA�,S,�IGNA[Uqy I DATE
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D-By- )
DATE
ATTENTION E)ff 1333 1/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A C RTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION log
04/02 PRESS HARD -YO�U ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW' INSFItCTC
PINK - OWNER GOLD - ASSESSOR
GREEN ACCOUNTING
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ..................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .... .........
YDP
Rough -In ...................
7, �MCX
Commercial Final ......
HEATING:
Gas Test ......................
GasPiping .................
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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