20040348.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
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ADDRESS
CITY
ZIP
TELEPHONE
NAME
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ADDRESS
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CITY ZIP
TELEPHONE
-71-7
91K02-DT
STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
1:1
RESIDENTIAL
PLUMBING / MECH
ADDITION
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COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
1:1
MULTIFAMILY
SIGN
REPAIR 1:1
GRADING FENCE X
CYOS FT)
DEMOLISH 1:1
OTHER
TANK
EiGARAGE [:]
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY El FIRE ALARM
(TYPE OF USE, BU*qS OR ACTIVITY) EXPLAIN
NUMBER eF
Lu NUMBER
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0 STORIES UNITS
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,5CRIBE WORK TO BE PONE
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PLAT NAME/SUBDIVISION NO
I PERMIT EXPIRES
PERMIT
NUMBER
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EX!STING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
0
RW Permit Required
13
Sir, it Use Permit Roq'd
E3
Inspvction Required
13
Sidewalk Required
13
Undergiound
Wiring ioquirrid
[3
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR AD13H I INSPECTION BOND
REO'D POSTED
0 YES ONO 1 $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED 13Y DATE
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REQ'D I PROVIDED I
REMARKS
CHECKED BY JTY� A�QFCO STRUCTION CO E OCCUPAN
GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
0(,HEATJOURCE GLAZING % LOT SLOPE %
At�;
Building Permit
City Surcharge
, �/ VESTED DATE
PLAN CHECK N2)Y
Plumbing
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT., 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 INTERESr. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
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Total Amt. Due
DEEMEDTo MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S 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 CONSTRUC-
CALL
This application is not a permil until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Depulyi and Fees are paid, and
receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
GNATUR DATE
0 IALS SI E
ATURE "WNER)OR DATE SIGNED
(425)
. . // //,, //
771-0220
DATE
RELEASED BY
7TTENTION
EXT 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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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