20040457.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
NAME
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CITY
NAME
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ADDRESS
CITY
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STATE LICENSE NUMBER
ZIP I TELEPHONE
ZIP TELEPHONE
EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
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ADDITION
REMODEL
'COMMERCIAL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
E:i RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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us NUMBER NUMBER OF
OF DWELLING
or STORIES UNITS X�
71
DESCRIBE WORK TO BE DONE
4-
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
CBL #
t P16
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT]
OTHER
FIRE SPRINKLER
FIRE ALARM
ILI
I PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
FESCP Approved 13
RW Permit Required 13
EXISIING — PROPOSED
Strout Use Permit Roq'd 13
inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION— FT
underground
Wiring required E3
METER SIZE
LINE SIZE
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NO, OF FIXTURES
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PRV REQUIRED
YES13 NO 13
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINEORADB# I INSPECTION PBOND
FlEq�!) OSTED
DYES
9NO I S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA REVIEWED BY DATE 5
REQ'D I PROVIDED I 'MA,0( 411 a -
REMARKS
CHECKED BY
JTYPE,��TION
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OCCUPANT
GROUP
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CRITICAL
AREAS
NUMBER
SPECIAL INSPECTION JAREA
REQUIRED [3 YES
IREMARKS
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER ILIBC 108/FINAL INSPECTION REO'D
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.
Lu PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI. 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 OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1111S PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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 #
Landscapelnsp.
Total Amt. Due
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. CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building official or his/lier Deputy: and Fees are 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 C OM PEN SA�PN-WkU RANCE AND RCW 10.27.
OFFICIALS SIGNAJURE DATE
SIGW—URE (OWNER OFQAGENT DATE SIGNED (425) 1
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RELEASED BY
771-10220 IDATEI
ATTENTION EXT 1333 4-1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL --------
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - Ft OW-INSIECTO(
y YELL R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK 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 ............. --j
M
Rough -In ................... C: 0
1711
0
Commercial Final ...... __10 : .
0
C
HEATING: M
ITIZ
Gas Test .................... ID --I
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Gas Piping .................
Equipment ................. CO)
0 -n
Commercial Final ....... n
--I
x
EXTERIOR SHEATHING M M
NAILING .......................... 0
0
0 M
FRAMING ........................ C: Cl)
0)
FIRST FLOOR FRAMING ... Q 0
Z r
INSULATION ...................
;U
Floor Insulation .........
>
Wall Insulation ........... z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ...
0
1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................