20040217 (2).pdfDATE RECEIVED
IT EXPIRES
LIST: PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
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(.2, PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
CE MAILING ADDRESS
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0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
_LL AW Permit Required
Sanot Use Parnet Pori'd 13
CITY ZIP TEi EPHONE EXISTING — PROPOSED inspecunnRequilod 13
Sidewalk Required E3
REQUIRED DEDICATION— Fr Underground
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NAME METER SIZE LIN �'�j NO. OF FIXTURES PRV REQUIRED
YES NO 13
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STATE LICENSE NUMBER EXPIRATTON DATE 9WECKED BY REQ'D POSTED
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NEW ESIDENTIAL X. LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (F-E)
PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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ADDITION COMMERCIAL COMPLIANCE OR 2
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PARKING LOT ARE PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED a.
REPAIR GRADING FENCE
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GARAGE RETAINING WALL FIRE SPRINKLER
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CHECKED BY TYP CONSTRUCTION C99E OCCUPANT
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NUMBER OF '�� ��Ail
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M OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
ci STORIES UNITS NUMBER REQUIRED [—
DESCRIBE WORK TO BE DONE _] YES LOAD
REMARKS
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VALUATION BE ACCEPTED
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
CK NO: VESTED DATE Plumbing Base Fee
Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
UA PERMIT APPLICATION: 180 DAYS
0. PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTERE�r. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt N
ir ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECrIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED *To MODIFY, WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE Total Amt. Due
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MI NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE TI IAT I I IAVE READ TI Its APPLICATION T1 IAT I'l IE INFORMATION
APPLICATION APPROVAL
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- 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 Official or his/tier Deputy: and Fees are paid, and
IN V61-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION1 receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION ��.�RANCE AND RCW 18 27. OFT LS SIGNA URE
DA E
SIGI�,AT�AE low R 0 ENT) DATE SIGNED
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771-0220 T'V
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RiLEAS6) BY DAT/
ATTENTION E)ff 1333
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*
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F(j(JNf)ATION':
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ................. L) )Z-6 /0
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FL06k FRAMING ...
'[�SULATION.
hoor In'sulation ..........
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Abblation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
ALFINAL APPROVAL FOR 5 ry7
OCCUPANCY ..................
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