20040322 (2).pdfDATE RECEIVED
USE
CITY OF EDMONDS ZONE
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CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS
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STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT P4RQEL NO.
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EXPIRATION DATE
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PERMIT
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LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO, OF FIXTURES
LID NO.
LID FEE S
TESCP ApYovga
RW polnut Required
street use prurnit Ron 'it
inspection Required
Sidriwalk Required
Underground
Wiring required
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
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FIRE SPRINKLER
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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: 180 DAYS
PERMIT LIMIT' I 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 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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL N01 HE
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.'
VMU Or
SHALL BE INSTALLED
DATE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOID a
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VALUATION
Description
, EPlan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
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 AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION. AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S 5QMQNS ION INSURANCE AND RCW 1817.
DATE SIGNED (425)
SIG URE((OWNEFtiOn AGENT)
771-0220
2 11�
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Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a pertnit until signed by the
Building 011icial or hisihor Dopuly� and Fees are paid, and
receipt is acknowledged in space provided.
OFFI . CIALS SIGNATURE TTE
RELEASrD BY DATE/
rff"l ; S 0 U7� � USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ON HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
A FINAL I WSCT11 PINK - OWNER COLD - ASSESSOR
GATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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JE: SETBACKS .....................
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FOUNDATION:
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m Footih .....
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Wall ..........................
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a) Pier/Porch .................
4-
Cis Retaining Wall ...........
4� 4�
4�
Slab Insulation ..........
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PLUMBING:
Underground ... ......
Rough -In ........... * .....
I 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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