20040301.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
C' I C� I
(-2, (7) L
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
0
141
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
CBLN
MO "PA
ZIP I TELEPHONE
DATE I CHECKED 13Y
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL
PLUMBING / MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
Er REMODEL MULTIFAMILY
SIGN
GRADING
E] REPAIR CYDS
FENCE
( x FT)
[:] DEMOLISH TANK
OTHER
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CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
0
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF .7
STORIES
NUMBER OF
DWELLING
-
CRITICAL
AREAS
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UNITS
NUM13ER
DESCRIBE WORK TO BE DONE L-A C_c�
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LOT SLOPE %
PLAN CHECK NO: VESTED DATE
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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.
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W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
1111 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
13 IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
or
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
0'
1XI NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
PERMITEXPIRES
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USE PERMIT ;;I crc I r)-:2
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NUMBER
JOB aj SVITE/APT#
ADDRESS C., <�-- ��j
PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
Fjw Permit Required
Street use Permit Roq'd
EXISTING - PROPOSED
inspection Required
sidewalk Required
FIFOUIRED DEDICATION� F1
Underground
Wiring roquirod
METER SIZE RES
PRV REQUIRED
YESA NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU HORELINE OR ADB# I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR 0
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I I
REMARKS
CHECKED BY I TYPE OF
OCCUPANT
GROUP 9
SPECIAL INSPECTION
OCCUPANT
REQUIRED [:] YES
JAREA
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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FEE I Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
T
TotalAmt.Due :511-5T
11 Receipt # I Mr,
APPLICATION APPROVAL
This 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.
OFFiCIA1,,S SIGNATUR DATE
(425)
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MOT, F1
ATTENTION'- E)ff 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
I HETIEBY 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 -nIEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN�q_CQMYENSATION INSURANCE AND RCW 18.27.
DATE SIGNED
7 A. _7)i i-
VALUATION
DC) 0
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
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ORIGINAL - FILE YELLOW - INSpECTp
PINK - OWNER GOLD - ASSESSOR
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...............
Commercial Final ......
EATING:
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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 v1h
OCCUPANCY .................. __yLL_
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