20040231.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER tXPIRKrION DATE I In I
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< PROPERTY TAX ACCOUNT PARCEL NO.
J_ 0071 woon (i
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
w NUMBER
NUMBER OF
OF
DWELLING
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UNITS
DESCRIBE WORK TO BE DONE
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FIRE ALARM
CRITICAL
AREAS
NUMBER
HEAT SOURCE GLAZING % LOT SLOPE %
_G_� I I
PLAN CHECK NO: I VESTED DATE
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.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT'. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL ULAIM5 t-OR 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
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 LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN�S-qOMPENSATlgt4,WUR,�KqE AND RCW 18.27.
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PLAT NAME/SUBDIVISION NO
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PERMIT EXPIRES �j / C�I
PERMIT
NUMBER
SUITEIAPT#
LOT NO.
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Inspection Requili
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Sidewalk Requir
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTRO11 ngAiNAr.F
Regardless of whether the water system
is open or closed, expnnsion tanks are
FIRE REVIEWED BY
DATE
DATE
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EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING DATE 5
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REMARKS
CHECKED BY ITYPE e&PQNSTFjLJ_ICTjQN
- I I CODF; OCCUPANT
SPECIAL INSPECTION
AREA TOCCUPANT
REQUIRED [] YES
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
City Surcharge
FEE
r-ire rieview Plan Chk. Deposit
Fire Inspection Receipt #
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIALS SIGYATURE DATE
(425)
771-0220 R L �/p
ELEASED BY
ATTENTION
IT IS UNLAWFUL TO USE OR OC/UPY A BUILDING OR STRUCTURE UNTIL EXT 1333
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
04/02 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'Pprlg ...............
-Vj T d"v 1- 5,01 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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