20040288.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP I TELEPHONE
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NAME
ADDRESS
CITY ZIP ]TELEPHONE
NAME CBL P
yefe,54-riu--r-
ADDRESS
118cL57 oL.: \I(OTX
CITY ZIP TELEPHONE
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STATE LICENSE 14UMBER EXPIRATION DAT.E CHECKEFD
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PROPERTY TAY Arrr.)IlKfT PARCEL NO
El
NEW
P,
RESIDENTIAL
ADDITION
M
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
El
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS R ACTIVITY) ii
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
EFENCE
( -X
OTHr)o -Y
--7— C L
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE PERMIT rj, I Nrj
ZONE
JOB SUITE/APT#
ADDRESS
10
PLAT NAMEISUBDIVISION NO. LOT NO LID NO
LID FEE $
sCP ,pprrivod
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HW parmit Roquirod
S1,001 U50 permit Heri'd
inspection Roquirod
EXISTING — PROPOSED Sidpwalk nequjiod
Undeigiound
REQUIRED DEDICATION— FT w,fing inquired
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I - YES 0 NO 11
REMARKS
OWN ERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
VARIANCE OR CU SHORELIN-�QRADB# I INsPEEc:riON I BOND
REI D POSTED
S �18r�
No S
__j[01YES ONO S
SEPA REVIEW
COMPLETE , EXEMPT
EXP
NUMBER NUMBER OF CRITICAL 14
OF DWELLING AREAS / 4_j
STORIES I UNITS I I NUMBER
DESCRIBE WORK TO BE DONE
"ecjj�'E'l I -A"
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
LOT SLOPE %
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 I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN1. 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 NAI URE, ARISING DIREC FLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL. NOI* BE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE C1 IYS ABIL11Y 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 AGRLE 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 1 B 2 7.
DATE S'71GN
SIGNATURE (OWNER OR,,�Ai)
P/ A
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
SPECIAL INSPECTIO
REQUIRED [] YES
SIGN AREA HEIGHT
ALLOWED . PROPOSED ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED 13Y DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
W
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D I log
VALUATION
$ 101
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge .5,
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
1=V'r -1 rifirl
Plan Chk. Deposit
Receipt #
Total Amt. Due 305o 5(
Receipt N I
APPLICATION APPROVAL
This application is not a pernist until signed by the
Building 011icial or his/liar Deputy: and Fees are paid, and
receipt is acknowledged in space provided. I
rNCIAi.S,SIGNATURF/I If DATE
ATTEfITIO'N
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
091;03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY DA
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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