20040162.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
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NAME
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STATE LICENSE NUMBER
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ZIP
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ZIP TELEPHONE
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EXPIRATION DATE I CFtF.GKe9,L0Y
06-106
PROPERTY TAX ACCOUNT
PARCEL NO.
NEW
RESIDENTIAL
F�
ADDITION
COMMERCIAL
E]
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACjIVIT`r�,ENPjqIN:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
FT)
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
-1
uj NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS
M UNITS NUMBER
0 STORIES
DESCRIBE WORK TO BE DONE
0 C-7-
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HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO: 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: IBODAYS
PERMIT LIMIT1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SLICCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTUY OR INDIREC I ILY
FROM THE ISSUANCE OF THIS PERM] r. ISSUANCE OF I HIS PERMIT SHALL. NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
PERMIT EXPIRES
USE
ZONE
PERMIT
NUMBER
JOB
ADDRESS
.7
SUITEIAPT#
PLAT NAMEISUBDIVISION NO
LOT NO
LIU NO.
I
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved 13
Fiw Permit Required 13
street Use Permit Roq'd [3
EXISTING
— PROPOSED
inspection Required 13
SIdew,lik Required 13
REQUIRED DEDICATION—
Fr
Underground
Wiring required 0
METER SIZE
LINE SIZE
NO, OF FIXTURES
I
PRV REQUIRED
I
YES 1:1 NO El
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU ON
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PRED PS POSED
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COMPL T We
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EX
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
0
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z
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PARKING
LOT AREA
REVIEWED BY DATE
REO'D I PROVIDED
tPLANNING
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; TIIAT 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 AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN V61-ATION OF THE LABOR -CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT�ON IN91JR�NCE AND RCW 18.27.
siONATOE (0%%NER 0 f
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DATE SIGNED
REMARKS
CHECKED BY I TYPF
R70ST
, _ ;T
P110 N C OCCUPANT
GROUP
SPECIAL INSPECTIOf4 AREA OCCUPANT
LOAD
REQUIRED [] YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 2i
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
_, I
Plan Chk. Deposit
Receipt H
Total Amt. Due
Receipt #
` �Y_- 7
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FFICIALS SIGhATURE — i QATE
I-
Via
RELEASED
ATTENTION E)ff 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09,,03 PRESS HARD -YOU ARE MAKING 4 COPIES
CALL
FOR INSPECTION
(425)
771-0220
DAT
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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0
11
0
M
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0 M
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0
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
0
Pier/Porch ................. I
0
Retaining Wall ........... M
Slab Insulation ..........
--n
PLUMBING: 3:
ITI
C
Underground,.%---"" M 0
0
__10
Rough -In ................... 0 C
Commercial Final ...... 3: M
M Z
HEATING: g)
C —Z
Gas Test ....................
3:
Gas Piping ................. 0 -n
-n
Equipment.................
Commercial Final ....... IT! 171
0
EXTERIOR SHEATHING 0 ITI
NAILING .......................... C Cn
9 Cn
ITI 0
FRAMING ........................ Z r—
FIRST FLOOR FRAMING ...
INSULATION ...................
z
Floor Insulation .........
--I
3:
Wall Insulation ...........
z
Ceiling Insulation ....... 0
SHEETROCK NAILING ... 0
171
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Zcoq 0