20040347.pdfDATE RECEIV�D
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
-2,7,0 7,
CITY ZIP I E C4/0.5
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TELEPHON
6,70 16 3
NAME
ADDRESS
CITY ZIP
TELEPHONE
USE
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JOB
ADDRESS
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PLAT NAME/SUBDIVISION NO.
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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EXPIRATION DATE CHECKED BY
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
9—
ADDITION
COMMERCIAL
REMODEL
M MULTIFAMILY
REPAIR
o GRADING CYDS
DEMOLISH
13 TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, Bust
Ss OR ACTIVITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
0`1
PLUMBING MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMB- /V/jtf
JER
O—URCE-1 GLAZING % LOT SLOPE %
HEAT S
VESTED DATE
PLAN CHECK NO: I
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
R R
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
I
I (CUR I ETC.) WILL REQUIRE
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES,
_j SEPARATE PERMISSION.
I=
cc PERMIT APPLICATION: 180 DAYS
PS
!MIT.
PERMIT LIMIT: I YEAR - PROVIDED WORK 15 STARTED WITHIN 100 DAYS
" . , , '10
SEE 13ACK OF PINK PERMIT FOR MORE INFORMATION
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OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESO
W IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
_j AND AGENTS FROM ANY AND
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPt OYEES.
WHATEVER NATURE, ARISING DIRECTLY OR INDIREC'l IN
ALL CLAIMS FOR DAMAGES OF SHALL NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE C"S ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.'
PERMIT EXPIRES
PERMIT Z,
N U M B E R
SUITEIAP i ff
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 $
71;E7ZSZP �APP( V
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RW pe,,,t Fi,quired
Street Use permit Hoq'd
inspection Required
Sidowalk Required
underground
wiring required
PRV REQUIRED
YES [3 NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
3 AD13tt INSPECTION BOND
VARIANCE OR CU AD N EQ ON BOND D
POSTE
B"
I SP T I LS
RE
ES 6D No
REQ'D POSTED
OYES ONO S
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
SPECIAL INSPECTIO
REQUIRED [] YES
GHT
PROP.
HEIGHT
SIGN AREA
P 0 LLO PROPOSED
ALLOWED PROPOSED ALLOWED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
FRONT SIDE REAR
LOT AREA PLANNING REVIEWED BY
AREA
DATE
OCCUPAN;0,��
GROUP
OCCUPANT
LOAD
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
77-777—_
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
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-
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V61-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKMEN'S COMPENSATION INSURANCE AND RCW IB.27.
S N "T I Rr�lbe DATE SIGNED
IG
�/I� —] 1/ 1
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
CALL
CTION
FORINSPE
(425)
771-0220
EXT 1333
Plan Chk. Deposit
Receipt III
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
%6AL� Sir, TURE DATE
L
RE
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CEFTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE - YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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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 ... -04
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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