20040436.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
MAILING ADDRESS
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NAME
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CITY ZIP 1 ELEPHONE
NAME
ADDRESS
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CITY I/ ZIP TELEPHONE
STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO.
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11
NEW
AErRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
"PE OF USE, BUSINESS OR ACTIVIDIWILAIN
CBL #
DATE I CHECKED BY
0 0
;K'*�PLUMBING
I MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
FO
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OTHER
FIRE SPRINKLER
FIRE ALARM
Lu NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS
M
0 STORIES UNITS NUMBER MAI
DESCRIBE WORK TO BE DONE
I
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
13 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE Ciry OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALI- CLAIMS FOR DAMAGES OF W14ATEVER NATURE, ARISING DIRFC rLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
0 ORDINANCE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY
P 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 STArE 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 CO11PFNSATION INSURANCE AND RCW 18.27,
tGNATURE ��OWNER 6R AGENT) DATE SIGNED
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USE
ZONE
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO
PERMIT EXPIRES I 4L, 41
PERMIT
NUMBER
SUITEiAPT#
LOT NO. LID NO.
LID FEE $
IESCP Approved
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
Street use Permit Roq'd
13
EXISTING - PROPOSED
I
inspection Required
Q
Sidewalk Required
E3
REQUIRED DEDICATION- FT
Underground
Weing required
METER SIZE
LINE SIZE
NO, OF FIXTURES
I
PRV REQUIRED
I
YES 1:1
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADEIII I INSPECTION
REO'D
OYES ONO IS
SIGN AREA 1 1-
WED . PROPOSED I ALLOWED
BOND
POSTED
MT
PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT L/R SIDE REAR U)
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PARKING LOT AREA I PLANNING REVIEWED BY DATE IL
REO'D I PROVIDED I
REMARKS
CHECKED BY ITYPE C111 ONSTRU,CT]Qp CQDE. -, OCCUPANT/-' 7
11' ) GROUP
ptl , U -
SPECIAL INSPECTION JAREA UL;L;UFANT
REQUIREDE] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REOID
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
L/. N
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
ATYE Nr 10 N tx I
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
Plan Chk. Deposit
Receipt H
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Total Amt. Due
Receipt # 1 -7
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
REI EASED BY DATE
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Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final ........
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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