20040226.pdfI
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DATE RECENED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP TEIEPHONE
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STATE LICENSE NUMBER EXPIRATI07 DATE HECI(Ef
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PROPERTY TAX ACCOUNT PARCEL NO,
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NEW
El RESIDENTIAL
PLUMBING <E DCH�
ADDITION
zo'�C OMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT)
DEMOLISH
TANK
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RETAINING WALL
ROOKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER OF
CRITICAL
OF
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DWELLING
1 UNITS
AREAS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
VESTED DATE
USE
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ADDRESS 7
PERMIT EXPIRES
PERMIT
N U M B E R
21 q a- - Fr'i -�"T- Y. %,V SUITE/APT#
PLAT NAME/SUBDIVISION NO. I LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE S
TESCP Approved
13
RW Permit Required
E3
Street Use Permit Floq'd
13
Inspection Required
E3
Sidewalk Required
13
Underground
Wiring required
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PRV REQUIRED
YES IJ NO 13
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP -X'
LOT COVERAGE
ALLOWED PROPOSED
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PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY I TYPE
SHORELINE OR ADB# I INSPECTION BOND
I- REO'D POSTED
YES s
SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS 0.)
FRONT SIDE REAR FRONT UR SIDE REAR
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LOT AREA I PLANNING 9&IEWED BY DATE
SPECIAL INSPECTION JAREA
REQUIRED [
OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS 1
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D C3
VALUATION
Description
Plan Check
Building Permit_
Plumbinn
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
PERL41T APPLICATION: 180 DAYS Engr. Review
CIL PERMIT LIMIT' 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
1W1 SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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FEE Description
State Surcharge
City Surcharge
FEE
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
* EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M Fire Inspection Receipt #
* ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION T5
Recording Fee Receipt
1 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 APPLICATION APPROVAL
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 TITE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided,
WORKMEN'S COMPENSATIOI�
,,.JNkURANCE AND HOW 18.27. OFFICIALS SIGNATURE �ATE/'
SIGNATURE (OWNER �VGENT) I "? .1
DATE SIGNED (425) C7
CIL
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771-0220 RELE DA E
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ATTENTION EXT 1333
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- -------- 0 1 ;�!GIN L-JFILE YELLOW -ANSPECTO'R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK'- 0) OWNER GOLD-ASSESSO�
04,102 PRESS HARD -YOU ARE MAKING 5 COPIES 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 ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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