20040177.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEPNAME/NAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOJJIF PARCEL NO.
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NEW
lESIDENTIAL
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ADDITION
[:] COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
PYPE OF USE, BUSINESS OR ACTIVILY). 1�4PLAIN:
uj NUMBER NUMBER a
OF DWELLING
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0 STORIES z� UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLAN CHECK NO:
>91105, LUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
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: 180 DAYS
PERMIT LIMIT. 1 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 SUCCESORS
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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE 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 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN SAT!PN.I�S URANCE AND RCW 18.27.
SIGNATURE (OWNER OR DATE IGNE
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1/11 1,*",/ AV41111 11 1" 1 1 1
H. 1 1 PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
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PLAT NAME,1SUBDIVISION NO LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC HIGIII OF WAY PER OFFICIAL STREET MAP RW Permit Required [3
Street Use Permit Roq'd 11
equired [3
EXISTING PROP �Fw, Required
un efg und
f'REOUIRFI) D E 1) ICA I I QN f4rwoP*fVP_4-- Wdina juirod El
l4wy,"ISIZ.�E — 1099P 111P V REQUIRED
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RAINAGE
ENGINEERING REVIEWED By
DATE
FIRE jE1,Mtfd?). Electrical Permit frY. ft,
OR cu
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERA
ALLOWEI
�HORELINEORADB# I INSPI�CTION BOND
POSTED
--fo—Y'ESONO is
FSIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
PARKING LOT
REQ'D I PROVIDED I
REMARKS
CHECKED BY
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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PROGRESS INSPECTIONS PER UBC 1 08/FINAL INSPECTION REQ-D 5
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
N
FEE Description FEE
State Surcharge
City Surcharge
77� V
CALL
FOR INSPECTION
(425)
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due
'17)
Receipt #
APPLICATION APPROVAL
I his application is not a perinit until signed by the
Building Official or tits/her Deputy: and Fees are paid, and
receipt is acl%nowledged in space provided.
OF F1 C lAi 7S I /GkAT U R XE/ D TE
RFI. FASFD fl� DATE
ATTENTION j Wk I I jai
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
OHIGINAL FILE YELLOW - INSPECTOR
PINK OWNER COLD ASSESSOR
GIAELN ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .................
'Wall ........................
Pier/Porch ..................
Waff"'. ...........
Slab Insulation ..........
PLUMBING:
.� ............ "I
Ro 611-10 ................
ComTercial -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 ..................
V-100� e.
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