20040473.pdfI
DATE RECEIVED
CITY OF EDMONDS
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CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER WtRATION DATE CHEFKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL PLUMBING / MECH
El ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
REPAIR rYDq El I, X FT)
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY E] FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUM E OF CRITICAL
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STORIES UNITS NUMBER
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HEAT SOURCE
PLAN CHECK NO:
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USE PERMIT
ZONE NUMBER
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JOB SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
I OT NO.
LID NO.
LID FEE S
IF SCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
HW Permit Roquund
Street usir Permit Reit'd
EXISTING - PROPOSED
Inspection Hequirod
sidewalk Roqeired
REQUIRED DEDICATION- FT
Undrifgmund
Wiring required
METER SIZE
I LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
YES El NO El
REMARKS
OWNERICONIRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
ORELINE OR ADB# INSPECTION BOND
REO'D/. POSTED
K DYES )2JNO IS
SIGN AREA HEIGHT
ALLOWED , PROPOSED I ALLOWED . PROPOSED
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
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REMARKS
CHECKED BY ITYPE OF CONSTRUCTION CODE OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG' B
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Description
FEE
Description
FEE
Plan Check
State Surcharge
GLAZING %
LOT SLOPE % Building Permit
VESTED DATE Plumbing
City Surcharge
Base Fee
—_ (_-4 4 Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (cunas, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 1130 DAYS
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PERMIT LIMI-P I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
SUCCESORS
Fire Review
Plan Chk. Deposit
:!55-11
V) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND
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Uj IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANYAND
Fire Inspection
Receipt 0
w RE, ARISING DIRECTLY OR INDIRECTLY
ALI- CLAIMS FOR DAMAGES OF WHATEVER NAT U
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
La ndscape Insp.
Total Amt. Due
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR J,lMI1 IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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Recording Fee
Receipt #
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APPLICATION APPROVAL
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
I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC,
CALL
This application is net a perina until signed by the
THE OWNER.
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 10
FOR INSPECTION
Building Official or hisilier Deputy� and Fees are paid, and
receipt is acknowledged in space provided
0 iGNATURF DATE
WORKMEN'S COMPENSAl ION !g�14RANCE AND RCW 11127.
21471
SIGNWRE (OWNER F� DATE Sl ED (425)
t� TIN
DATE
771-0220 RETFASFD
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN�L-�)(E YELLC%V -INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PiNK-OWNER Gnto ASSESSOR
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ........... 0
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Slab Insulatio 0
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PLUMBING:
Underground ............. —4
0 M
Rough -in ................... C
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0
Commercial Final ......
0 C:
HEATING: M
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Gas Test .................... g) --i
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Gas Piping .................
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Equipment ................. 0 _n
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Commercial Final .......
EXTERIOR SHEATHING M M
NAILING .......................... 0
0
FRAMING ........................ 0 M
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FIRST FLOOR FRAMING ...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation ....... x
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SHEETROCK NAILING ... z
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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