20040291A.pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME E OF BUSINESS
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MAILING'AD DRESS
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CITY ZIP ITELEPHONE
NAME
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CITY ZIP I TELEPHONE
NAME ICBLO
ADDRESS
CITY I ZIP I TELEPHONE
PERMIT EXPIRES A
"Ur" 4/ — I I —
. TUSE PERMIT
ZONE NUMBER
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ADDRES
STATE LICENSE NUMBER ExPR_ATioN bATE CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
ADDITION
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COMMERCIAL
REMODEL
MULTIFAMILY
MULTI tj
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
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RETAINING WALL
ROCKERY
l[TYPE OF US"USINESS OR ACTIVITY) EXPLAIN:
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NUMBER OF
NUMBER
OF DWELLING
STOO UNITS
DESCRIBE WORK TO BE DONE
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PLUMBING / MECH
COMPLIANCE OR
USE
CHANCE OF
SIGN
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FIRE SPRINK�ER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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11111 PE %
HEA'T' "fa�u,�CE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
SUITE/APT#
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
1
LID FEE $
TESCP ApPr ved
Escp
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PUBLIC RIGIIT OF WAY PER OFFICIAL STREET MAP
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REQUIRED DEDICATION� FT
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LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
METER SIZE
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YES 13 NO E3
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 1BO 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 NATURE, ARISING DIRECVIY OR INDIRECTLY
FROM THE ISSUANCE OF T141S 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 BULY 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 V;6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0= DATE S)GNED
SIGNATLAE (OWN�EF1191`1 AGENT) �_ I - I I I ; _ , .0
REMARKS
OWNER/CONTRAClOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINE OR ADB# I INSPE.CTION BOND
RE 'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE- EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SET13ACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR t5
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PROVIDED
REMARKS
F N ON D OCCUPANT
CHECKED BY OF CONS RUCTION CODE
TY GROUP
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTION!SPE7RUBC I 081FINAL INSPECTION REQ'D —
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
FFire Inspection
s sp.
Landscape'llcnsp.
Recording Fee
FEE Description FEE
State Surcharge
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City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
r.vy _1Iq"1q
Plan Chk. Deposit
EE LReceEipt#
Total Amt. Due
Receipt 0
APPLICATION APPROVAL
This application is not a permit until signed by the
Building otticial or his/her Deputy: and Fees ate paid, and
receipt is acknowledged in space provided.
T HE
I S S7
LFASFD BY
ATTENTION LL�
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
09iO3 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 .................
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 ..................
ILAL.100
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