20040294.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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STATE LICENSE NUMBER EXPIRATION DATE CHECKEI
'LAAT4/T'-U-V0
ROPERTY TAX ACCOUNT PARCEL NO.
0 NEW
RESIDENTIAL
PLUMBING I MECH
F-1 ADDITION
COMMERCIAL
1'--'�!COMPLIANCE
OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
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DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
El
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE. 13USINESS qe-4TIVITY) "EXWIN:
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NUMBER NUMBER OF CR ITI G L
OF DWELLING AREAS
STORIES UNITS NU JE
DESCRIBE WORKITO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
W
CL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) $APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
@ IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI.ESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
CC TI.
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIREC TIY OR INDIREC Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT 13E
DEEMED 10 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION"
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, IHAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY Willi CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF T14E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW IS 27.
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SIGN�A�UAE (OWNER I& AGENT) DATE SIGNED
PERMITEXPIRES
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USE PERMIT.7kT[ -07; C
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NUMBER ct
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JOB _,SUITE/APT
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Applo�rrd E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW permit I-loquired 13
street Use Permit Roq'd (3
inspection Renuilod E3
EXISTING — PROPOSED Sidewall, Required
Underaforind
REQUIRED DEDICATION— FT d
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to
I wiring re"I"IL
METER SIZE IZE NO. OF FIXTURES I PRV REQUIRED
YES C—I NO 1:1
RE
1. --;;— expallislon
is open or closed,
Irequiread.on all not w8ter tall
Oty Me. M)E) j92.30-0201
ENGINEEFUNG REVIEWED By
FIRE REVIEWED BY
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO S
T—SIGN AREA HEIGHT
I ALLOWED . PROPOSED I ALLOWED , PROPOSED
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT URSIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED BY ITYP,F OF CONSYRUCTION OCCUPANJ�
GROUP
SPECIAL INSPECTION 'JAREA UL;L;UFAN I
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 1 08/171NAL INSPECTION REQ'D
A49/t i /�o .41,p /e, Ir /;-I mx— 0e1A117'-- in
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge A.
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Base Fee r)
Plan Chk. Deposit
Receipt #
Total Amt. Due z:� 70
Receipt 0 9�4
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provideq
OF�CIA151'JIGNATURE A t rjAT E
ATENTION r.7% I I
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
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TE
ORIGINAL -FILE YELLOW. INSPECTOR
PINK -OWNER GOLD�ASSESSOFI
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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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