20040399.pdfFDATE —RECEIVED
CITY OFIEDIVIONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF 13USINESS
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MAILIN(;AD6RESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP TELEPHONE
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NAME CBL#
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ADDRESS
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CITY I P TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHEGVd!Q4
PROPERTY TAX ACCOUNT PARCEL.NO. It
XNEW
0 RESIDENTIAL PLUMBING / MECH
ADDITION
COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY SIGN
REPAIR
GRADING
CYDS
FENCE
13 ( X FT)
DEMOLISH
TANK
1:1 OTHER
oGARAGE
RETAINING WALL
F RE SPRINKLER
1:1
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF
3
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
NUMBER
DESCRIBE WORK TO BE DONE jg t-'r-9-
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHEC&NO. VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPUCATION: 180 DAYS
PERMIT UMM I YEAR ' PROVIDED WORK IS STARTED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIF4 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 CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HERE13Y 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 STAIEE 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 COMPENSATICI�WURANCE AND RCW 18,27.
SIGNATURE/gWNEPA , GE DATE SIG ED
9 Z-/ I I PERMIT EXPIRES /,1;
USE PERMIT
ZONE 22MY NUMBER
JOB SUITE/APT#
ADDRESS c?_/_
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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LLD F I
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
Street Use Permit Roq'd
EXISTING — PROPOSED
inspection Required E3
Sidewalk Required CI
REQUIRED DEDICATION— FT
Underground
Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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-_NGINEERING REVIEWED BY TE
FIRE REVIEWED BY DATE uA
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SHORELINE OR ADB#
I INSPECTION
BOND
POSTED
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TREO'D
(:]YES ONO
s
$EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
'ALLOWED PROPOSED
EXP ,
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,
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SET13ACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT.,.. L/RSIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED'BY
DATE
REO'D I PROVIDED
REMARKS
CHECKED BY TYP C N co OCCUPANT
%SA GROUP A h 2-
SPECIAL INSPECTION JA REFA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG'D
VALUATION
$ ---------- —
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscape Insp.
Total Amt. Due
Recording Fee
Receipt #
U L-1 Z11 4-1
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
APPLICATION APPROVAL
Th s application Is not a permit until signed by the
BuildinIg Otficial or his/her Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
S GN7RE DATE
L'A
RE& EP BY, DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL - I I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORI ' GINAL - FILE YELLOW -INSPECTC
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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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
q,2. �d
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Com mercial, Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Ini6lation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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