20040253.pdfa
FDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PER MIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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11 NEW le -RESIDENTIAL E] PLUMBING / MECH
E] ADDITION COMMERCIAL COMPLIANCE OR
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CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING FENCE
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, Bus S OR ACTIVITY) EXPLAIN:
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NUMBER OF
CRITICAL
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DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: 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
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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UJI PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS -THE CIT-Y OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT LIE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYs A131LITY 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 TIIE 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 10 27.
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES /L-x �z 4, �2
PERMIT
N U M B E R
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LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- Fr
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
13
RW Parmit Required
13
Street Use Permit Raq'd
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Inspection Required
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Sidewalk Required
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Underground
Wiring required
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PRV REQUIRED
YES 11 NO 13
REMARKS
OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADBI
INSPECTION
BOND
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POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
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LOT COVERAGE
REQUIRED SETBACKS JFT)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
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LOT AREA
PLANNING REVIEWED BY DATE
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REO'D I PROVIDED
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REMARKS
CHECKED BY jr4PA OF CONSTRUCTION COkjE OCCUPANT
GROUP
SPECIAL INSPECTION
OCCUPANT
REQUIRED [] YES
JAREA
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
$ J;9 / /./.� _�
Description FEE Description FEE
Plan Check State Surcharge
Building Permit raw City Surcharge
Plumbing Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
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Recording Fee Receipt #
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APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/tier Deputy: and Fees art, paid. and
FOR INSPECTION receipt is acknowledged in space provided
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J-�MS SIGNAT RE DATE
(425) 1/
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771-0220 —*DATE
RFI_6�f�fBY
ATTENTION Exr 1333 -------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
OF41GINAL - 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 .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
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0
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground .............
0 M
C
Rough -In ................... M 0
0
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Commercial Final ...... 0 C
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X M
HEATING: M z
Gas Test .................... C —Z
Gas Piping .................
Equipment ................. 0 -n
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Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING .......................... 0
0 M
FRAMING ........................ C cl)
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M 0
FIRST FLOOR FRAMING... Z r-
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INSULATION ................... ;U
Floor insulation .........
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Wall Insulation ........... __I
Ceiling Insulation .......
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SHEETROCK NAILING ... 0
1
SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................