20040199.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PC4 n Ck Fox
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
LERMIT EXPIRES
P
USE PERMIT
ZONE N U M B E R,
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ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE i NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved
13
Rw Permit Required
E3
Street Use Permit Roq'd
E3
Inspection Required
13
Sidewalk Required
Underground
Wiring required
E3
PRV REQUIRED
YES 13 NO 0
ADDRESS
E AR K S
REMARKS
M
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
0 W N E R' CONTRA'
CITY
ZIP TELEPHONE
LENGINEERING
NAME
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIF
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
I
E] DEMOLISH
TANK
EiGARAGE
RETAINING WALL
El
CARPORT
ROCKERY
(TYPE OF U USINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
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STORIES
UNITS
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DESCRIBE WORK TO 13E DONE
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COMPLIANCE OR
CHANGE OF USE
SIGN
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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PLAN CHECK NO: oy� V2 VESTED DATE
0
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.
cc PERMIT APPLICATION: 180DAYS
Lu
IL PERMIT LIMIr 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANr, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAIURE, ARISING DIRECTIY OR INDIREC11Y
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOI BE
9 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 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 COMPENSATION INSURANCE AND RCW 18.27.
SIGN� �(OWNER OtrAGENT) DATE SIGNED
VARIANCE OR CU
HORELINEORAD111
INSPECTION
BOND
RECI'D
I
POSTED
I
OYES WO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLO ROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACkS' (FF.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
PARKING
LOT AREA
PLANNING REVIEWED BY BAT
REO'D PROVID ED
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REMARKS
CHECKED BY I TYPE O\VUCTION f*ej OCCUPANT
GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQa'D
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge 'LL 4::��
Building Permit City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit k
Fire inspection Receipt #
LandscapeInsp. Total Amt. Due 1�;
Recording Fee Receipt it
APPLICATION APPROVAL
This application is not a permit until sighed by tire
CALL Building Official or lus/her Deputy: and Fees are paid, and
FOR INSPECTION (ecLipt is acknowiodged in space provided.
OFFICIALS SIGNATURE DATE
(425) Mx'/
771-0220 �Ef�.ASED BY DAYE
ATTENTION EXI 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLCFW`- INSFIECTC
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ........... .
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
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FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR -2-
OCCUPANCY ..................
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