20040382.pdfFDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
�R NAME/NAME OF BUSINESS
I PERMIT EXPIRES
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LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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PLUMBING / MECH
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ADDITION
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COMPLIANCE OR
CHANGE OF USE
1:1
REMODEL
MULTIFAMILY
SIGN
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REPAIR
FENCE
( X FT)
GRADING
CYDS
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TANK
OTHER
oGARAGE
o RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINJ�S 9R �&IVI EXPLAIN:
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NUMBER
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NUMBER OF
DWELLING
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CRITICAL
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NUMBER
DESCRIBE WORK TO BE DONE
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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 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, 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 I HE 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 CITY'S 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 CONSIRUC-
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION PF THE LABOR C9DE OF THE STATE OF WASHINGTON RELATING TO
W0174NI WSMPENS29�[_W9fJRANCE AND RCW 10.27.
q_1rhRTURE L6WNEP(O6(AGEQ77---, I DATE SPNED
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LID FEE $
I ESCP Approved
RW Pormit Required
Street Use Pannit Roq'd
Inspection Required
Sidewalk Required
Undritipound
Wiring required
PRV REQUIRED
YES 13 NO 1:3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
RECI'D I PROVIDED
REMARKS
CHECKED BY ITYPE jC11, UST LICTION C�E U U L, U rA N
GROUP
SPECIAL INSPECTION AREA OCCUPANT
QUIRED [] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQU Ei
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VALUATION
$ C)
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
Description
F
State Surcharge
City Surcharge
Base Fee
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Plan Chk. Deposit
Receipt #
Total Amt. Due 1, 5b
Receipt # /7/
APPLICATION A LL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space Pf ovided.
-FIC A.S SI NATURE VATE
AlIENTION E)ff 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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW !INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
M
PLUMBING:
-n
Underground .............
Cn
Rough -In ................... 0 M
C
0
M 0
Commercial Final ...... —10
0 C
HEATING:
M
M z
Gas Test ....................
Gas Piping .................
Equipment .................
0
Commercial Final ....... _n
EXTERIOR SHEATHING M M
NAILING ..........................
0 6
0
FRAMING ........................ 0 M
C Cn
Cn
FIRST FLOOR FRAMING ...
M 0
Z
INSULATION ...................
Floor Insulation .........
3:
Wall Insulation ...........
z
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Ceiling Insulation .......
Cn
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
A7
FINAL APPROVAL FOR
OCCUPANCY ..................