20040398.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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1/' 1, A, r, V I I PERMIT EXPIRES
UXE PERMIT
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ADDRESS
PLAT NAMEISUBDIVISION NO
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LID NO,
LID FEE $
TESCP Approved�13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Street Use Pom: Roq'd
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EXISTING - PROPOSED
inspection Required
Sidewalk floquirod
13
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FIFQUIRFD DEDICATION- FT
Undeiground
Wiring roquirod
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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ADDRESS
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CITY ZIP TELEPHONE
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STATE I lCFNSE NUMBER EXPIRATION DATE I CHEICI�EDBY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
FCMIULTIFAMILY
REMODEL
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
Ej
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
APLUMBING / MECH
—COMPLIANCE OR
CHANGE OF USE
SIGN
EFENCE
( x FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
REMARKS
OWNER/CON TRACI Oil RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENC31NEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU —1 SHORELINE OR ADIII I INSPECTION I BOND
REQ'D POSTED
OYES ONO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED OPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
Pt RSUANT1 TO ECDC 19.30.020
REMARKS E�SNUFJ-.K U-K)LAIUK VALVE(PRN)
U) 'I NUMBER OF CRITICAL
W NUMBER
0 OF DWELLING AREAS
111 1 NUMBER 411t4
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
GLAZING %
LOT SLOPE %
THE WATER S
CHECKED BY ITYPE70NSTRIJCJ IN COPE OCCUPANT
GROUP
VAJ48 KV j
SPECIAL INSPECTIONJAREA OCCUPANT
REQUIRE LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REa'D
PURSUANT TO UPC 605.2
VALUATION
CHECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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OAPPLICANI. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
A P P I C A
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IN INTERESI. AGREES TO INDEMNIFY, DEFrND AND HOID HARMLESS THE CITY OF
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EDMONDS. WASHINGTON, ITS OFFICIALS. EMPIOYEES, AND AGENTS FROM ANY AND
E D M 0 N D
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ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE. ARISING DIREC111Y OR INDIR C Y
A L L C A
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FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF 1111S PERMIT SHALL NOT BF
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DEEMED 10 MODIFY, WAIVE Oil REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
D E E M E D
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NOR LIMIT IN ANY WAY I HE CITY'S ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION."
N 0 R I M
I I VIERE13Y AC KNOWLEDGE THAT I HAVE READ 1111S APPLICATION; THAT THE INFORMATION
H Y C
IVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IS C
G V C
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E E OW RUC
THE OWNER. I AGRI�E TO COMPLY WITI I CITY AND STATE LAW,'; REGULAI ING CONSI
T It- N
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
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V I - OL T� 0 1 RELATING TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN'S COMPENSATION RANCE AND RCW I B 27
Wo M S
SIGNATURE (OWNER 0
S IC TU _ ( G�1�
DATE SIGNED
IE AS IT ENTERS THE BUILDING
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
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Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I hisapplication is riot a pennit Until signed by the
BUilding 011icial or his/tier Depuly:and Fees are paid, and
'� . receipt is acknowledged in space provided.
rE C AYURF DATE
f IS SIGP4
RF1 EASFD
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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
091M PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD-ASSESSO11
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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 ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
.,INSULATIQN.....� ................
Fl6or Irisirlation .........
Wall Insulation ...........
Calling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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