20040400.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS J
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NAME
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STATE LICENSE NUMBER XPIRATIC CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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1:1 NEW AIRESIDENTIAL PLUMBING I MECH
1:1 ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
1:1 REMODEL MULTIFAMILY SIGN
a —REPAIR E] GRADING FENCE
CYDS ( x FT)
DEMOLISH TANK F1 OTHER
GARAGE RETAINING WALL o FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
F_ (TYPE OF USE, BUSINESq-C*k ACTIVITY) E�PLAIN:
.1 - CMTICAT
ul NUMBER NUMBER OF
OF DWELLING AREAS
UNITS NUMBER
o STORIES I I
DESCRIBE WORK TO BE DONE
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PERMIT EXPIRES
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USF PERMIT
ZONE NUMBER
JOB
ADDRESS 2
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PLAT NAMEISUBDIVISION NO. LOT NO. I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRE[) DEDICATION— FT
METER SIZE I LINE SIZE NO. OF FIXTURES
YAL
SUITE/APT#
LID NO
LID FEE $
7ESCP Approved
JiW P"Mit ljorl." rid
street Use permit 1300
inspection Refli"rild
Sidewalk Flarti4iied
un(jergrokind
Wiring coittlired
PRV REQUIRED
YES 13 NO E3
REMARKS
OWNERICONTRACIOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINE OR ADEIN INSPECTION BOND
REO'D POSTED
SEPA REVIEW SIGN AREA I OYES ONO Is HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I _LLi�
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR C5
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PARKING LOT AREA [FiLANNING REVIEWED BY DATE
REO'D I PROVIDED
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HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO: 31ik3I 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 OFwHATEVER NATURE. ARISING DIRECTI-YOR INDIRECILY
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 CONSTRLIC-
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 COMPENSATION INSqRq4CE AND RCW 18,27.
REMARKS
CHECKED BY 01 1131UIAII-V
ITYPE OF CONSTFjqCTION I COD GF
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D
VALUATION
I f VJA 0144,14
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 FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt N
APPLICATION APPROVAL
1-his application is not a permit until signed by the
Building Oflicial or his/lier Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
ATTONTION I V I EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL r
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
D BY
/ DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
0
M
PLUMBING:
--I n
Underground .............
�2a
M
C
Rough -In ...................
M 0
0
Commercial Final ......
0
0 C
HEATING:
M
M Z
Gas Test ....................
C) -1
C z
Gas Piping .................
Equipment .................
Commercial Final .......
__4
EXTERIOR SHEATHING
M M
NAILING ..........................
00)
0
0 M
FRAMING ........................
C 0)
FIRST FLOOR FRAMING ...
Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
z
__4
Ceiling Insulation .......
SHEETROCK NAILING ...
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0
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SPECIAL INSPECTION ...
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
4(
OCCUPANCY ..................
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