20040323 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER ME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP ITELEPHONE
USE
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I PERMIT EXPIRES_
PERMIT
NIJIMBERAffZl—Z9,6e,�
ADDRESS
PLAT NAME/SUBDIVISION NO LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE F �NOOF FIX
ITE/APT#
�14evr
LID NO.
LID FEE $
IESCP Approved
0
RW Parme Required
13
Street Use Prinnit Hoq'd
13
Inspection Flecluirrid
Q
Sidewalk Required
13
Underground
Wiring required
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PFIV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NAME
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ENG114EERING REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBI INSPECTION BOND
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SIGN AREA HEIGHT
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PROPERTY TAX /CCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROP
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NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
EMODEL MULTIFAMILY SIGN REQ'D I PROVIDED
GRADING FENCE
REPAIR CYDS x —Fr) REMARKS
DEMOLISH TANK F-1 OTHER
Ei GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, B4&HfiSS OR ACTIVITY) EXPLAIN:
rL CHECKED BY I TYPE OF CONSTRUCTION OCCUP�ba.'
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ui NUMBER 1�7) NUMBER OF CRITICAL V-7774-Y
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DESCRIBE WORK TO BE DONE a
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D Zi
[6-1AJ 12-t I!5�100� M
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Fire Review Plan Chk. Deposit
(n 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
UJI IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt It
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTIYORINDIRECILY
x FROM THE ISSUANCE OF T141S PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
0 Landscapelnsp. Total Amt. Due
_j DEEMED 10 MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION' Recording Fee Receipt 9
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DUL� AUTHORIZED AGENT OF APPLICATION APPROVAL'
I AGREE TO COMPLY WIT I I CITY AND STATE LAWS REGULATING CONSTRUC. I t1is application is not a perinit Until signed by tire
THE OWNER. CALL Building ollicial or his/hor Deputy: and Fees are paid. and
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL. BE EMPLOYED
IN Vi6LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN,S,��MP
'_�NSATION INSURANCE AND RCW 1&27 OFFICIALS SIGNATURE DATE
SIGNATU -1 WNE� RtGENT DATE SIGNED
(425)
771-0220 DATE
11171 AS Y
ATTENTIt E)ff 1333 n
IT IS UNLAW 1 0 USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL � / , k' zA' /Z'
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YELLOW -IN PECT
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER - GOLD -ASSESSOR
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
-in ....................
Rough
commercial Final ......
HEATING:
Gas Test .................... .
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
6
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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