20040364.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME Or BUSINESS
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NAME
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PLAT NAME/SUBDIVISION NO.
LID NO,
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appr7v-ed13
RW Permit Required
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EXISTING - PROPOSED
Street Use Permit Roq'd
inspection Required
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Sidewalk Required
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REQUIRED DEDICATION- FT
Underground
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Wiring required
METER SIZE
M T R S I Z
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION 13OND
STATE LICENSE NUMBER EXPIRATION DATE Y REO'D POSTED
DYES ONO S
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SEPA REVIEW SIGN AREA HEIGHT
J% PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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F-1 NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D PRO
REMODEL 11 MULTIFAMILY SIGN = VIDE D IL
GRADING FENCE
REPAIR 101 CYDS 1:1 ( x Fr) REMARKS
DEMOLISH 1:1 TANK Ei OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT 0 ROCKERY 1:1 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVIM EXPLAIN:
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0 OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
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0 STORIES -2, UNITS NUMBER REQUIRED [:] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PERUBC 108/FINAL INSPECTION REQ-D F5
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Descr'iption FEE Description FEE
-5 Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
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UA PERMIT APPLICATION: 180DAYS
lo. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
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IN INTERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS I HE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIr. ISSUANCE OF THIS PERMIT SHALL NOT 13F
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Total Amt. Due
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCF
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NOR LIMI1 IN ANY WAY THE CITYS ABILI IY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee
Receipt #
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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 AGRLE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application is not a pertnit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or tits/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LANR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
recLipt is acknowledged in space provided.
WORKM�V'S COMPENSATION �NSURANCE AND RCW 111,27
OFFICIALS SIGNAILIF
F. DATE
SIGN ER OR AGE
DATE IGNED
(425)
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FASED BY 1. DATET
ATTEWION
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 i'INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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:
GasTest .................... --------------
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
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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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