20040273.pdfDATE RECEIVED.,�
I PERMIT EXPIRES
USE
CITY OF EDMONDS ZONE PERMIT
CONSTRUCTION PERMIT APPLICATION
OWNER NAMt/NAME OF BUSINESS
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NAME
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NAME
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ADDRESS
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STkTE �LICENSE NUMBER
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ZIP
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PROPERTY _(AX ACCOUNT PARCEL NO,
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EXPIRATION DATE CyjCKEI
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NEW
RESIDENTIAL
PLUMBING/MECH
IADDITION
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COMPLIANCE OR
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CHANGE OF USE
1:1
REMODEL
MULTIFAMILY
�SIGN
11
REPAIR
FENCE
GRADING
CYDS
( X FT)
1:1
DEMOLISH
TANK
OTHER
0
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
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Lu NUMBER NUMBER OF
a CRIfTICAL
m _!F0 DWELLING AREAS
a ST RIES UNITS NUMBER
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DESCRIBE WORK TO BE DONE
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JOB 01V NUMBER, f
ADDRESS
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SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
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LID NO.
LID FEE $
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
13
RW Permit Required
13
EXISTING . PROPOSED
Street use Penfut Roq*d
inspection Required
0
13
REQUIRED DEDICATION� FT
Sidewalk Required
underground
E3
Wiring required
13
METER SIZE LINE SIZE
SIZE LINE S NO. OF FIXTURES
PRV REQUIRED
No 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADS# I INSPECTIOV f— 13OND
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COMPLETE EXEjM
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EXP I ,^
LOT COVERAGE
REQUIRED SETBACKS (Fr.) PROPOSED SET13ACKS (IT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE HEAR
PARKING Vl� LOT AREA I PLANNING REVIEWED BY DATE
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REO'D I PRO D
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REMARKS
OCCUPANT
GROUP
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SPECIAL INSPECTION AREK/ OCCUPANT
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PLAN CHECK NO: I VESTE �DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
:3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
M
W 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
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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 N07 BE
DEEMED TO MODIF4 WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.ft
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[I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TI
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WWORKMEN'S COMPENSATION INSURANCE AND RCW IB.27.
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SIGNATURE (OWNE GE DATE SIGNED
Description
San Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTI,
(425) (
771-0220
FEE Description FEE
Y' C) State Surcharge
11W City Surcharge
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION
APPROVAL
This application is not a permit until signed by the
Building Official or hisihor Deputy: and Fees are paid, and
receipt is acknowledged in space Provided,
1IFIC)APP SIGNATUA DA
Dru VT- 6ATE
ATTENTION EXT 13'33
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 ORIGINAL - FILE -YELLOW 4INSCTC
04/02 PINK -OWNER GOLD -ASSESSOR
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 ........... z
Slab Insulation ..........
0
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PLUMBING:
Underground .............
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Rough -In ........ .......... M
C:
M 0
Commercial Final ...... 0
0 0
HEATING:
3: M
M z
Gas Test .....................
C:
Gas Piping ....... ......... z
3:
Equipment .............
0 -n
C ommercial Final ....... n
EXTERIOR SHEATHING
M M
NAILING ..........................
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FRAMING ........................ 0
C M
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FIRST FLOOR FRAMING ... Q)
M 0
Z
INSULATION ........... .......
Floor Insulation .........
Wall Insulation ...........
Z,
Ceiling Insulation .......
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SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................