20040267.pdfDATE RECEIVED
USE
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Clly OF EDIVIONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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CITY
NAME
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ADDRESS
CITY ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX qOCCRCEL NO.
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TELEPHONE
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TELEPHONE
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EXPIRATION DATE C
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
r.AAPr)AT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVIr) E.XP�,Alli:
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w NUMBER L
I NUMBER OF
0 OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
PLUMBING t MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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HEAT SOURCE GLAZING % LOT SLOPE %
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
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THL ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED 10 MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY wAYTHE CRYS 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
DATE SIGNED
IV) Ll — 0
SIGNAIPEF,(VN O�,6GENT)
PERMIT EXPIRES
PERMIT U I
NUMBER ;�
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� Fr
METER SIZE LINE SIZE NO. OF FIXTURES
SUITEIAPT #
I I
LID NO
LID FEE
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st"61 Use Permit "I'd
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inspection Requited
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Undefgiound
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PRV REQUIRED
YES 0 NO C3
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
EERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
BOND
VARIANCE OR EUTSHORELINE OR ADBI I INSMEG ION
IE�
I
0
F 3 D POSTED
OYES 0Nd_S_.
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDED
REMARKS
SIGN AREA I ALL HEIGH I
ALLOWED . PROPOSED OWED I PROPOSED
REQUIRED SET13ACIKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR I FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY DATE
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CHECKED
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TYPE OF
OCCUPANT
GROUP
SPECIAL
REQUIRED
INSPECTION
[3 YES
377
AREA
OCCUPANT
LOAD
REMARKS
PROGRESS
INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D z
$
LUATION
Description
Plan Check
Building Permit
FEE Description
State Surcharge
City Surcharge
FEE
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. inspection
Fire Review
Plan nK. Depos t
Fire Inspection
Receipt #
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
#3
�±Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or hisitier Deputy: and Fees are paid, and
receipt is acknowledged in space provi.ded.
lkfCIAV�,SIGNATUREA JDATE
ATTENTION r.A I 1%3a
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
BY
DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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z
0
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0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch ................. 0
--I
0
Retaining Wall ...........
Slab Insulation ..........
:n
PLUMBING:
0 M
Underground ............. C 0
M 0
Rough -In ...................
0 C
Commercial Final ......
X M
M Z
HEATING:
c
Gas Test ....................
Gas Piping .................
o n
n
Equipment ................. __4
x
M M
Commercial Final .......
0 _Cn
EXTERIOR SHEATHING r—
M
NAILING .......................... C Cf)
Cn
FRAMING ........................ M 0
Z
FIRST FLOOR FRAMING...
INSULATION ...................
r
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Floor Insulation ......... z
Wall Insulation ...........
C/)
Ceiling Insulation ....... z
0
I
SHEETROCK NAILING ... 0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................