20040244 (2).pdfDATE RECEIVED
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USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAMEINAME OF BUSINESS -7
MAILING ADDAESS
CITY
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NAME
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NAME
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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MULTIFAMILY
REPAIR
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CYDS
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TANK
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RETAINING WALL
1:1
CARPORT
ROCKERY
CrYPE OF USE. BUSINESS
OR ACTIVITY) EXPLAIN:
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'4UMBER OF
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AREAS
NUMBER
LOT SLOPE %
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 CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC FIY OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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-
I HEREBY ACI
G kEN
IV IS CC
T' IE OWNER
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIO IN OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS URANCE AND RCW 18.27.
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�YE NE A CE_N DATE SIGNED
PLAT NAMEIS
PERMIT EXPIRES
PERMIT
NUMBER
NO. LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� FT
METER SIZE LINE SIZE NO. OF FIXTURES
REMARKS
OWNER/CONTRACTOR RE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR M
fED BY... -
SEPA REVIEW
COMPLETE EXEMPT
EXP I
KING
6LI
#
LID NO.
LID FEE $
TESCP Approved
11
fjw, Permit Floquifed
13
Street Use Permit Floq'd
13
Inspection Required
[3
Sidewalk Required
0
Underground
Wiring required
13
PRV REQUIRED
YES13 NO 13
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SHORELINE On AD1111 INSPECTION BOND
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REMARKS 9
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
M
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt N
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
L_-7 11
CALL
FOR INSPECTION
(425)
771-0:220
APPLICATION APPROVAL
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.
OFFICIALS SI AT E T E
I , /
RF1 FAAED B� D&E
A17ENTION EXT 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
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES
0111GINAL - FILE YELLOW - INSPECTOR
PINK . OWNER COLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS* .................
FOUNDA
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Footing........................
Wall ..........................
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Pier/Porch ................. 0
Retaining Wall ........... 0
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Slab Insulation ..........
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PLUMBING: -j
Underground ............. M
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Rough -In ................... __10
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HEATING: -
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Gas Test ..... .............. >
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Gas Piping .................
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Equipment ................. _n
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Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
C:
FRAMING ........................ Q 0
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FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ........... 3:
ceiling Insulation ....... z
0
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SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR all I/ /V 4�
OCCUPANCY ..................
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