20040183.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
DINER IIIIEIT;ME 0,F'1BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECK_qV BY,
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PROPERTY TAX ACCOUNT PARCEL NO,
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NEW XRESIDENTIAL PLUMBING MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR 0 CYDS ( X FT)
El DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE.BUSINESS OR ACTIVITY) EXPLAIN
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C' OF DWELLING AREAS
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0 STORIES UNITS
7it DESCRIBE WdRK TO BE DONE
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PERMIT EXPIRES
7SF PERMIT
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ADDRESS *z,2_&ejo
PLAT NAME/SUB LOT NO� LID NO.
LID FEE $
JISCP �Applmld
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP nw Permit Requircid
street uso Porma Floq'd
EXISTING - PROPOSED inspection Required
Sidewalk HenkilMd
Undeiground
REOUIRED DEDICATION- Fr Wiring reqUIred
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 0 NO E3
REMARKS
OWNER/C
ENGINEERING
FIRE REVIEWED BY
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DATE
DATE
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ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR C5
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PARKING LOT AREA I PLANNING REVIEWED BY DATE IL
REO'D I PROVIDED
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REMARKS
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REaD
CHECKED BY I TYPE OF
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOUR�E GLAZING % LOT SLOPE %
Building Permit City Surcharge
Base Fee
PLAttCHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 100DAYS
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IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn Fire Review Plan Chk. Deposit
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-.1
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
a: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
9 DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee R eceipt #
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 Au'niORIZED AGENI OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building 011icial or his/her Dcputy� and Fees are paid, and
IN V�6LATION OF THE LABOR CODE OF THE STATE OF WASIJINGTON RELATING To FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW IB 27. IGNATu DATE
RE (OW10 AGZET) D]TLEIGNE (425) , .1 t7k,
EXT 1 ASED BY
-0220 —T—DArTr
771
ATTENTION 333
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 - GOLD - ASSESSOR
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
lat.
is I i.,*p i '1134offf, ..... .....
...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ............ ......
Commercial Final ......
HEATING:
Test
Gas ....................
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
3
OCCUPANCY ..................
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