20040370.pdfa
DATE RECEIVED
PERMIT UC/
EXPIRES
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAME/NAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
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MAILING ADDRESS
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FUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I LSCP AppfoVnd
Hw Pormit RoqUired
EXISTING - PROPOSED
street use Parent Roq,d C3
inspection Required 13
CITY ZIP
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Wiring requited 0
NAME
METER SIZE
LINE SIZE
OF FIXTURES
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YES 13 NO
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ADDRESS
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
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ENGINEERING REVIEWED BY
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DATE
ADDRESS
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FIRE REVIEWED BY DATE
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VARIANCE OR CU
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BOND
POSTED
STATE LICENSE NUMBER ExpiHATION DATE
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OYES ONO
SEPA REVIEW
COMPLETE , EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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PROPERTYTAX ACCOUl`jT PARCEL NO.
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NEW PLUMBING if MECH
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
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CHANGE OF USE
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PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN
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GRADING FENCE
E] REPAIR CYDS E] ( X FT)
REMARKS
DEMOLISH TANK OTHERL
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT
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ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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GROUP
NUMBER
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NUMBER OF
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CRITICAL
AREAS
SPECIAL INSPECTION
OCCUPANT
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STORIES
UNITS 1
N\I-\-
NUMBER
REQUIRED
YES
JAREA
LOAD
DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description FEE Description FEE
Plan Check
State Surcharge
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HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
HECK NO:
VESTED DATE
Plumbing
Base Fee
�5 0
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
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DOMAIN (CURBS, SiDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180DAYS
Engr. Inspection
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PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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 INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIREC1 LY
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FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT TIIE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
APPLICATION
APPROV
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TV . V, MV�T "I I I I Ul I T AND STATE LAWS REGULATING CONSTRLIC-
TION 'AND Ir ING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLAT — " �F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKM�W'S COMPEN�ATION INSURANCE �ND RCW IH 27.
CALL
FOR INSPECTION
(4 2 E i)
1 his application is not a perinit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
OFFI)l PL.�K"§I�SNAWRE
SIG . URE
ATE SIGNED
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7A:,RNTION 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
ORIGINAL FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall............... I ..........
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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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