20040322A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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7 61 Aii�o
CITY
NAME
ADDRESS
CITY
S
CITY
ZIP I TELEPHONE
7N /0 , - /
ZIP I TELEPHONE
STATE LICENSE NUMBER
E
'ROPERTY TAX ACCOUNT PARCEL NO.
7
NEW
Rf—RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
13 MULTIFAMILY
REPAIR
0 GRADING CYDS
DEMOLISH
0 TANK
GARAGE
-1 RETAININGWALL
1:1
CARPORT
ROCKERY
(rYPE OF USE. B
OR EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORI:2�
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING %
PLAN CHECK NO:
CBL N
USE
ZONE
JOB
ADDRESS '71
J PERMIT EXPIRES
PERMIT
N U M B E t 12 =,'-,
ZOUITE/APT#
1<1/1
PLAT NAME/SUBDIVISION NO.
LOT NO.
L�D NO.
L D FEE $
I tsur, Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
Street Use Permit Req'd
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
13
CI
OUIRED DEDICATION— FT
9
underground
Wiring required
CI
METER SIZE
LINE SIZE
NO. OF FIXTURES
REQUIRED
YEPRIVII NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
— I — — _
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
IATION DATE
CHECKED BY
REQ'D
PBOND
OSTED
OYES ONO s
1EXP
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED
PROPOSED,
I
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
PLUMBING / MECH
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT I
UR SIDE REAR
.-,<POMPL ANCE OR
z
CHANGE OF USE
PA KING
LOT AREA REVIEWED BY
DATE
SIGN
REO'D
I PROVIDED
o FENCE
I
6AS
l[PLANNING
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111-UP—HIN1110 I BE
( — X—FT)
REMARKS
El OTHER
OBSERNFR
AY
OlfHNSPEMR
F RE SPRINKLER
AiRWITS
SHALL NOT
no
FIRE ALARM
__
CHECKED BY N TRUCTION
1 coor. OCCUPANT
ITYPE
P-77 GROUP �P_
CRITICAL
- 4: -
-,
AREAS
SPECIAL INSPECTION
OCCUPANT
NUMBE R 411
JAREA
REQUIRED [] YES
LOAD
R REMARKS
PROGRESS INSPECTIONS PER UBC
F
108/FINAL INSPECTION REGID
7 ?
VALUATION
Description FEE
Description FEE
Plan Check
State Surcharge
LOT SLOPE %
VESTED DATE
Building Permit
Plumbing
City Surcharge
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Iz
a
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERM17APPILICATION: 1180DAYS
CL
PERMIT UMrP I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
a
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
IALL
CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
9
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
Landscape Insp.
Total Amt. Due
0
NOR LIMIT 114 ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL/
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 CONSTRLIC-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees Oro paid, and
IN I THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged In space provided.
WORKMEN' ENSATION INSURANCE AND
-
OPFI/I LS SIG�AT�IRE DATE
SIG 0
DATE SI ED
('425)
771-0220
G-1/00
TELCASECrOY
ENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL -FILE - YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping ..............
Equipment.................
Commercial Final ........
EXTERIOR SHEATHING
NAILING ..........................
FRAMING .........................
'�;FIRST FLOOR FRAMING...
iNSULAT16N...'.e ..............
Insulation
,Floor .........
�te- Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
AIM
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