20040402.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/AP I ff
CONSTRUCTION PERMI T APPLICATION ADDRESS- - 6)
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDREdS LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 'd
street use Permit Raq
CITY ZIP ITELEPHONE EXISTING — PROPOSED inspection Required
Sidewalk Required
Underground
'le REQUIRED DEDICATION— Fr waingfaquired
4'If ",d) 4_� 30 nei 9
NAME METER SIZE LINE SIZE NO. OF FIXTURES PFIV REQUIRED
I I I YES [3 NO 13
ADDRESS REMARKS
I OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP TELEPHONE
NAME CBL#
cf—'e'4;— I &I �� � ENGINEERING REVIEWED BY DATE
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12 CITY ZIP TELEPHONE rZ
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VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
STATE LICENSE NUMBER EXPIRA'rION PATE CH KED BY REO'D POSTED
I OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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EXP
LOT COVERAGE REQUIRED SETBACKS (n) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PCOMPLIANCE OR
ADDITION El COMMERCIAL CHANGE OF USE
_rING REVIE QL
PARKING LOT AREA WED BY DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE I I
1:1 REPAIR 1:1 CYDS El ( x Fr) REMARKS
OTHER
DEMOLISH El TANK 1:1
o GARAGE RETAINING WALL E:] FIRE SPRINKLER
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(TYPE OF USE, BPqlNESS OR ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D a
Gre h0ke-P— IfVtk�; rVI-1
V (r V UAS PIPE TEST MUST BE
OBSERVED gy GITY INSPECTOR
r _C _'k-0 .Z_r _�q IV/ PIAO IZZ::: VALUATION WFIDAWIS SHALL NOT
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO. L4 VESTED DATE Plumbing Base Fee
12 rJ Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO ...........
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review ......... ......
...........
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
CAP 'APPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
@ IN INTERE�T,' AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
ml Recording Fee Receipt
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a Permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Olficial or his/lier Deputy: and Fees arc paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space Provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
.'1G ATURE DATE
A E�� DATE SIPNED
SIGNATUfjE_(OWNER 10, (425) z
771 -022
0 BY BAT
A17ENTION Diff 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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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
C�;mni4rci�l Final ......
HEATING':'
Gas Test ....................
Gas Piping ................. 5)o
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
'INSU
r ....................
T.� Ot4
loor Irisulati6n .........
W all 176sulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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