20040350.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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NAME
ADDRESS
CITY
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ZIP TELEPHONE
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PERMITEXPIRES
USE PERMIT
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NUMBER
JOB SUITE/APT#
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PLAT NAME/SUBDIVISION NO. LOT NO, LID NO. I
LID FEE S
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
LIC R I
FAW Permit Required 0
Street Use Permit Req'd E3
XIS T G
EXISTING PROPOSED
inspection Required 0
nod C3
*UIRED DEDICATION
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:Underground
Wiring requir
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NO. OF FIXTUFft Inee
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YES U NO
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OW�ER/CONTRACTOR
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NAME CBL Or is open or closed, expansion tanks are
DATE
�vater tanks per
ADDRESS
I Q'ity Code. ECDC j9.30.020 (c)
605 ZOO-' ST, DATE W
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CITY ZIP TEILEPH E PIPE TEST MUST BE
�o )9 �e - BOND
CHECIS�D VARIANDW �UHW LI POS
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STATE LICENSE NUMBER E:<PiRxri6N DATE Ift BY AFFIVAVITS SHAI.4cNff8NO S TED
4-Lovesip"CI-71i S/3/95 k, SEPA REVIEW HEIGHT
COMPLETE EXEMPT ELAC UPPTEDSED ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO. PURS
58-2 003 N'T TO �,CDC 19-20.020
co, -0002- Q.5 EXP Al P "�n�
EUMMftJ Ty'r UR SIDE REAR
LOT COVE P ID SETBACKS (Fr.)
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NEW RESIDENTIAL PLUMBING MECH ALLOWED PF%r BOOMST)I&Lff N �X z
ADDITION COMMERCIAL COMPLIANCE OR WATER '9F1rrr(-)_ z
CHANGE OF USE 4 z
PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
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REMODEL D MULTIFAMILY SIGN REQ IDED
GRADING FENCE L
E] REPAIR 0 CYDS ( X Fr) REI ARObtaija -Flectrical Permit frm
DEMOLISH 0 TANK OTHER __ --fo & Industries
State Lab
EiGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITO EXPLAIN: OCCUPANT `7
CHECKED BY IfikE 0 ONTT�RLCTION GROUP (E
KIES) bF,)JC:L �0
NUMBER N UM BER OF CRITICAL JAREAI OCCUPANT
OF DWELLING AREAS SPECIAL INSPECTION LOAD
STORIES UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE
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INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 3
C, Lt PROGRESS
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6,�Nf -r Description FEE Description FEE
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Plan Check State Surcharge
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HEAT �OU CE - GLA4NGk LOT SLOPE % Building Permit City Surcharge
G 711, j K T,) I VESTED DATE —
PLAN CHECK NO: Plumbing 30
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
r PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. 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
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 'THIS PERMIT SHALL NOT BE mt. Due
M DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total A
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt #
1 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 This application is not a permit until signed by the
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 Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RGW 18.27. OF ICIA1 " SIGNATURE D TEE
WNE *46Etl) DATE SI NED (425)
SIGNAT&
L 771-0220 1.1 -AI'ED BY DATE/
AT-fENTION 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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RECOkb',OF INSPECTIONS
INSPECTOR DATE APPROVED
..............
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Footing ..................
Wall`.� ............ .......
Pier/Pbrch .................
;j,.. Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
',:Under ou-nc1:'.'; .........
14-
Ro . ugh -in ................... Ae �___ �(_
Commercial Final ....... f
-HEATING:-
'Gas ....................
iping .................
Ga*s Pi
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
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OCCUPANCY ..................
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