20040433.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTR UCTION PERMIT APPLICATION
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LICENSE NUMBER
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
CARPORT
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RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINE90-qR ACTIVIM EXPLAIN
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w NUMBER -VUMBER 0
OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
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PLUMBING ir MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x Fr)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
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: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIr 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 REGULAI ING 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 COMPENSATJQ�L INSURANCE AND RCW 18.27.
DATE S
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L,L� I PERMIT EXPIRES 1 1-f4 k-
USE PERMIT
ZONE NUMBER
JOB UITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TIESCP Approved
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use Permit Roci'd 13
EXISTING — PROPOSED Inspection Requited Q
Sidewalk Required [3
REQUIRED DEDICATION— FT Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I- YES 1:3 NO 0
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIFWED BY DATE
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15
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VARIANCE OR CLI HORELINE OR ADIIII I INSPE.CTION BOND
RE, 0 POSTED
OYES ONO I s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (IT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PUANNING REVIEWED BY DATE
REQ'D I PROVIDED I I
REMARKS
CHECKED TYPE (IF CONST N C09E OCCUPANT" —
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D z
VALUATION
Description
FEE
Description
M177
F E E
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 #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
2
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPRO;rAL
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 provided.
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/#I'EASED BY
AT'I'MTIONI'A IF E)ff 1333 t
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 ..........
M
PLUMBING:
-n
Underground .............
ITI
Rough -In ................... C
M
0
Commercial Final ...... -10
0 C
HEATING:
M
M z
Gas Test .................... --I
_z
Gas Piping .................
Equipment .................
0 _n
Commercial Final .......
EXTERIOR SHEATHING
M M
NAILING .......................... 0
0
FRAMING ........................ 0 M
C
Cn
FIRST FLOOR FRAMING ... Q 0
Z
-1
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation .......
C/)
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... I
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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