20040264.pdfI
DATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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TANK
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GARAGE
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RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
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NUMBER OF
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ITICAL
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NUMBER 13
DESCRIBE WORK TO BE DONE
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LOT NO.
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PUBLIC RIGIIIT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
5
RW Permit Required
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EXISTING PROPOSED
Street Use permit Ftoq'd 13
inspection Required 13
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU HOREILINE OR ADIII I INSPECTION BOND
REO'D POSTED
OYES ONO � s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED ROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
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PARKING LOT AREA I PLANNING REVIEWED BY DATE :5
REQ'D I PROVIDED CL
FT) I REMARKS
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
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
OAPPLICANT. 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 AGENIS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDinEC*l LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF rHIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE Cl rYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION '
CHECKED BY I TYPE F CMR��C'��O -
OCCUPANTE'-7,>
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
1PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit__
Plumbing
Mechanical 10
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
7C
(425)
771-0220 R
A17ENTION V - 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
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 AGENI 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 13E EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI-0141-11919TURITANCE AND RCW 18,27,
SIGNAB#RE (OWNE�IOVRGEN I DALE S NED
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Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt #
APPLICATION APPROWAU7
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
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;ED BY DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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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 ...
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FINAL APPROVAL FOR
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