20040377.pdfDATE RECEIVED
[PERMIT EXPIRES
USE PERMIT
ZONE
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS 7FM I q i -q*
OWNER NAME/NAME OF BUSINESS
V PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
tr MAILING ADDRESS LID FEE $
Lu
7ESCP Approved
RW permit Required [3
lor' PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Street use permit Roq'd 13
C ITY inspection Required [3
ZIP TELEPHONE EXISTING — PROPOSED Sidewalk Required [3
REQUIRED DEDICATION. FT Underground 13
y" J— — ��( " � —ff- Wiring required
f 71 _T
NAME METER SIZE LINE SIZ� NO. OF FIXTURES PRV REQUIRED
U I YES 0 NO 13
W
1= ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE
NAME
CEIL 11
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ADDRESS
2e,-)Y1 7
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CIT ZIP
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TELEPHONE (T
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STATE LICENSE
NUM13ER EXPIRATION DATE
CHECKEa BY
/0
PROPERTY TAX
ACCOUNT PARCEL NO.
NEW
E] RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
E]
COMPLIANCE OR
CHANGE OF USE
REMODEL
rRIMULTIFAMILY
SIGN
L4 REPAIR
FENCE
( x FT)
GRADING
CYDS
E] DEMOLISH
1:1 TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
0/
AREAS
STORIES
UNITS O—Ar
NUMBER
DESCRIBE WORK TO BE
DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
LOT SLOPE %
VESTED DATE
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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 'THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIObWt4aURANCE AND RCW 18.27.
SIGNATURE (OWNER OR (4ENT DATE SIGNED
FIRE REVIEWED BY
VARIANCE OR CU
__ ' I
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PRC
REMARKS
CHECKED BY
SPECIAL INSPECTIC
REQUIRED [:] YES
DATE
DATE
IORELNE OR ADB# I INSPECTION BOND
REO&O IS 'OST�
OYES
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/A SIDE REAR
LOT AREA I �LANNING REVIEWED BY
AREA
OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS a
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
I I s, (a),
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt It
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
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ATTENTION/ 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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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0 M
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M
Z
z
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z
0
A
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING: zn
co
Underground .............
0 M
C
M 0
Rough -In ................... 0
--1 0
0
Commercial Final ......
x IT11
HEATING: M z
C
Gas Test .................... > z
Gas Piping .................
-n
Equipment ................. 0
Commercial Final .......
M M
EXTERIOR SHEATHING a Cf)
NAILING .......................... 0 r-
0 M
cn
FRAMING ........................ 9 C/)
M 0
Z r—
FIRST FLOOR FRAMING ... ..A
INSULATION ................... ;0
Floor Insulation ......... >
z
Wall Insulation ........... -4
Ceiling Insulation ....... 0)
z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ... M
MISCELLANEOUS .......... .9
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile initials MT are Milton
Thompson, a temporary contract
inspector ror the City.