20040284.pdfDATE RECEIVED,,--7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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PERIMITEXPIRES L111U10
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PERMIT
NUMBER
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SUITEIAPT #
PLAT NAMEISUBDIVISION NO.
NO.
LID NO.
LID FEE S
FESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required C
Street Use Permit Roq'd E
EXISTING - PROPOSED
inspection Required r
Sidewalk Required C
REQUIRED DEDICATION- FT
Underground
Wiring
required
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES13 NO 13
REMARKS
OWN ER/CONTR ACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
J III ENGINEERING REVIEWEDBY
CITY
ZIP
TELEPH ONE
STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING MECH
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COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAI R
GRADING FENCE
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DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
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STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT sbURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: n I n 1-1f, 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 DIRECTLY OR INDIRECILY
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-
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 COMPENSATIPW4146I.&INICE AND RCW 18,27.
SIGNATJ�(OWNE OR
,�E DATE SIGNED
.........
ATT TIO
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
DATE
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SIGN AREA
HEIGHT
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ALLOWED PROPOSED
ALLOWED PROPOSED
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EXP
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
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FRONT LIFISIDE REAR
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PLANNING REVIEWED BY DATE
REO'D I PROVIDED
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REMARKS
CHECKED 13Y f PE =OFNS RUCTION C E
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17 GROUP
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SPECIAL INSPEC ION REA OCCUPANT
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REQUIRED E] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG'D
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VALUATION
$
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Description FEE_
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Description FEE
State Surcharge
City Surcharge
Fire Review Plan Chk. Deposit t
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due z770 >S,-
Recording Fee Receipt #
APPLICATION APPROVAL
1 his application is not a permit until signed by the
CALL Building official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFAFICIS StGNATYRE DATE
(425) C
771-0220 RELEASED,I)Y f DATE
EXT 1333 'T--.///11
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WNER GOLD -ASSESSOR
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CITY
Copy
REcEIVED
10 4.8 3'
MAR 2 4 2004
00
PERMIT COUNTER
—241 ------- Existing
Residence
75
C)
0i
116
01i
New. lunroc
�On
10,
w Dec
_rzz
12
Driveway
ZONE
SETBACKS:
P.
FRON
SIDE
-7. 5'
Pb,�V:-r-�e C-c."wL-4�
REAR
11:5"
OTHER
00-� C\ 040 C3 0 -z'-1 C) 0
HE m
Parrott Residence
APPROVED J�Y
22516 72nd Pt, W.
Edmonds, WoL, 98026
Scatei 1'=20"
orthwest Sunrooms
P.O. Box 1332
AcKent, Washington 98035
G r,-, " N:�) (� 1� �� --�
-.-. - m
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
's -<S
Pier/Porch .................
Retaining Wall ........... M
Slab Insulation ..........
PLUMBING:
0 M
Underground ............. C 0
M 0
Rough -In ................... 0 C:
Commercial Final ...... X M
M Z
HEATING:
C
F_
Gas Test ....................
Gas Piping .................
Equipment .................
M M
Commercial Final ....... 0 —
C/)
0
EXTERIOR SHEATHING 0 M
C
NAILING .......................... CD
9 CD
FRAMING ........................ Q 0
Z
FIRST FLOOR FRAMING ... ;0
INSULATION ...................
z
Floor Insulation .........
Wall Insulation ...........
CD
z
Ceiling Insulation ....... 0
SHEETROCK NAILING ... 0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. Lo -