20040185.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER !N�JME/NAME OF BUSLUFSS
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PLAT NAMEiSUBDIVISION NO
PERMIT EXPIRES I
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PERMIT
NUMBER
SUITE!APTN
LOT NO LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
ME I ER SIZE LINE SIZE NO. OF FIXTURES
LID FEE S
TESCP Approved
0
R%11 Permit Required
0
Street U!.e Permit Req d
0
Inspection Required
0
SideAalk Requited
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Underground
Wiring requited
0
PRV REQUIRED
YES 0 NO 0
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED/DATE
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PROPERTY T�X POEL NO.
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ADDITION COMMERCIAL
C] REMODEL APARTMENT
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE o R WALL
RZINING
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OR
CHANGE OF USE
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CRITIC#A.,,
AREAS
NUMBER
LOT SLOPE
TESTED DATE
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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.
cc PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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LU IN INTEREST. AGREES TO INDEMNIFY. DEPEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOUI REMENT OF ANY CITY ORDINANCE
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01 NOR LIMIT IN ANY WAY THE C11 Y'S 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
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSI RUC-
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL HE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING 10
WORK EN'S COMPENSA=4CE AND RCW 18.27
(ItA URE jOV�N�R�R Ab� T) I DATE SJ14 J,,
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FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBP INSPECTION BOND
REO'D POSTED
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ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
LFRONT SIDE REAR
FRONT UPSIDE REAR
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PLANNING REVIEWED BY DATE
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REO'D I PROVIDED
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IT'1'3�NLAWFUL TO U1141 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
5198
OBSER
CHECKEDBY ITYPE
GROUP
SPECIAL INSPECTOR JhREA OCCUPANT
REQUIRED[:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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PLUMBING
MECHANICAL
GRAY%G/FILL
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ENG REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
PLAN CHECK DEPOSIT
TOTAL AMOUNT DUE
VALUATION
EIPT
FEE
APPLICATION APPROVAL
Thisapplication is not a pornIll Until signed by the
CALL Building official or his/her Depuly and Foes are paid.and
FOR INSPECTION receipt is acknowlLidged in space prowled
—IFIJJCII SIGNATU AT
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bATE
771-0220 79L E AS E D 6 Y
EXT 1333
771-0221
ORIGINAL - FILE YELLOW - INSPECTOR
FAX PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall....4 .......................
ier/08fc� ....... : ..... .....
qqtaioih�. Wall ...........
Slab Insulation ..........
PLUMBING:
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 1NL.JL,,,-ION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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