20040287.pdfI
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW.N�,R NAME/NAME OF BUSINESS
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NAME
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CITY ZIP TELEPHONE
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I --C)1:L I I PERMIT EXPIRES
USE PERMIT
ZONE NUMBER3010q— 0
JOB SUIT�APT#
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO, LID NO
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LID FEE $
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SGP Approved
I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
'U BLC RIG ' IT 0
RW Permit Required [3
street use Permit Req'd 13
PROPOSED
intipection required [3
Sidewalk floquired E3
LEXISTING
REQUIRED DEDICATION- FT
underground
Wiring required
M E F S I E
ETER SIZE
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LINE SIZE
XTURES
PRV REQUIRED
YES NO 13
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
OW RICO TR
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ADDRESS
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CITY ZIP TELEPHONE
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SI'MTE LICENSE NUMBER EXPIRATION 0 BY
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PROPE
OTY TAX ACCOUNT PARCEL NO,
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSVqSS OR ACTIVITY) EXPLAIN
VPLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
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C RITICAL
U) NUMBER NUMBER OF
111 1 AREA
'3 OF DWELLING S
M NUMBER
01 STORIES UNITS
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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. 1 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 10 INDEMNIFY, DEFEND AND HOLD HARMLESS T14E CITY OF
EDMONDS, WASHINGTON, I rs OFFICIAL S, EMPLOYEES, AND AGENTS FROM ANY AND
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECILYOR INDIRECHY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMI1 SHALL Nor 13E
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-0
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 AGR�E TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN V6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION UNSUJ,1ANCE �Nq, RCW IIL27,
DAL E SI 0
REVIEWED BY DATE
FIRE REVIEWED BY DATE LLJ
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
SEPA REVIEW SIGN AREA DYES CINO S HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED _ALLOWED PROPOSED
EXP I -
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
JR SIDE REAR
ALLOWED PROPOSED FRONT SIDE REARtFRONT I!d L5
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PARKIWG LOT AREA I PLANNING REVIEWED BY DATE CL.
REQ'D I PROVIDED I
REMARKS
CHECKED BY TYPE ON TRU ON UPANT
E N TRPUI "U""
BY 0 JOGGROUP
TYP j RE
SPECIAL IiNSPECTION AREA OCCUPANT
LOAD
REQUIRED [] YES:
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 5
1�� A M
47,
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
IT Review
Plan Chk. Deposit
10
Fire Inspection
Receipt #
WFire
Landscapelnsp-
Total Amt. Due
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Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
a
Building official at his/tier Deputy: and Fees are paid, and
FOR INSPECTION
receipt is acknowlodged in space provided.
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-ICfALIGNAT U D T
(425)
7
Z711 /_1
771-0220 /A E SED By PATE I
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
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ........... 0
0
Slab Insulation .......... M
PLUMBING:
rn
Underground ............. 0)
M
Rough -in ................... C.
M 0
--1 0
Commercial Final ...... 0 0
C:
-4
HEATING: 3: M
ITI Z
Gas Test ....................
C _Z
Gas Piping ................. --I
3:
Equipment .................
0 -n
n
Commercial Final ....... —4
M M
EXTERIOR SHEATHING
NAILING .......................... CD
0
0 171
FRAMING ........................ C C/)
CD
FIRST FLOOR FRAMING ... ITI 0
Z
INSULATION ...................
Floor Insulation .........
>
Wall Insulation ........... z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
1
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR S)77 (24
OCCUPANCY ..................
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