20040205 (2).pdfW
DATE RECEIVED.,e
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY 0
NAME'
I CITY
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J21
ZIP TELEPHONE
79�?
ZIP ITELEPHONE
CBL #
[PERMIT EXPIRES t
USE PERMIT
ZONE NUMBER /2
JOB 0,
IF OWN
ADDRESS `7ff t I
PLAT NAMEISUBDIVISION NO. LOT NO LID NO.
LID FEE $
TLSCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Hw Form, Roq":�Ild 13
Street U'o Per, led 0
EXISTING - PROPOGED inspection flocttillod Q
Selowalk Required E3
REQUIRED DEDICATION- FI tinderg(otind
0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO 13
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE (5
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ADDRESSU
CITY ZIP TELEPHONE
I STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY]
PROPERTY TAX ACCOUNT PARCEL NO.
F1 NEW
ff%RESIDENTIAL
XPLUMBING / MECH
EADDITION
1
COMMERCIAL
COMPLIANCE OR
1:1 CHANGE OF USE
E] REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT,
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSIN"S-qR ACTIVIT% EXPLAIN:
Ell I . I
uj NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS
M
0 STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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 (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180DAYS
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a. PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
11 SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
M IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
M
4 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
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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 T14E 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 TjIE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF T E LABQJA CODE OF THE STATE OF WASHINGTON RELATING TO
�YA S AT
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WORKMEW fi(INSURANCE AND RCW 18.27.
S , U E. /4G E !N:T) DATE I SIGNED
IC U E,
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED SED
PARKING
REO'D I PROVIDED
REMARKS
SHORELINE OR ADB# I INSPECTION BOND
R E O'D POSTED
0 0 0
YES ONO S
Y
SIGN AREA HEIGHT
LOW LLO , P
AL ED . PROPOSED ALLOWED , PROPOSED
REQUIRED SETBACKS (FF.) PROPOSED SETBACK� T' I
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FRONT SIDE REAR FRONT LJR SIDE EAR
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LOT AREA I PLANNING REVIEWED BY DATE Q.
CHECKED BY
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OCCUPANTe_:.17?
GROW
SPECIAL INSPECTION
UL;L;UPANT
REQUIRED [3 YES
LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC
108/FINAL INSPECTION REQ'D
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTR
(425)(
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL i
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
ZFl I SIGNAT E
,7147 1 / � � -
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�LtASED EY' 41 nATP
A NT Wk I I
IT I 7SN L ArUL 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
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch ................. 0
0
Retaining Wall ...........
M
Slab Insulation ..........
=i in
PLUMBING:
M
Underground ............. C:
M
0
Rough -In ................... __40
0 C
Commercial Final ......
M
M z
HEATING: IC)
Gas Test ....................
Gas Piping .................
0 -n
_n
Equipment.................
3:9
Commercial Final ....... M M
EXTERIOR SHEATHING 0 r-
0 M
NAILING .......................... CD
FRAMING ........................ M C)
Z
FIRST FLOOR FRAMING ...
INSULATION ................... -4
3:
>
Floor Insulation ......... z
Wall Insulation ...........
Ceiling Insulation z
0
1
SHEETROCK NAILING ... 0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................