20040477.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMF/NAME OF BVSINES�
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OSE PERMIT
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PLAT NAMEISUBDIVISION NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP TELEP IONE EXISTING - PROPOSED
(-AOLREQUIRED DEDICATION- FT
11771
NAME I METER SIZE LINE SIZE NO. OF FIXTURES
ADDRESS
CITY
ZIP I TELEPHONE
7'
SUITE/APT#
LID NO.
LID FEE $
TESCP Appo�ld E3
RW Permit Required Q
Street Use Permit Fleq'd 13
inspection Required E3
Sidewalk Required E3
underground
Wiring required
PRV REQUIRED'
YES 1:1 NO 1]
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE CHECK BY
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SEPA REVIEW
COMPLETE EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
HEIGH�T
ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL No.
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RESIDENTIAL LUMBING / MECH
NEW X
A—, COMPLIANCE OR
ADDITION COMMERCIAL 11 CHANGE OF USE
REMODEL MULTIFAMILY 1:1 SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
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PARKING
REQ'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
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GRADING FENCE
El REPAIR CYDS 0 ( X FT)
REMARKS
El DEMOLISH 1:1 TANK Ej OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
l CARPORT 1:1 ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS,,17
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CHECKED BY
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OCCUPANT
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NUMBER
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STORIES
'NUMBER OF
DWELLING
UNITS 7MEER
CRITICA
EAS
AREA
NU
NUM
SPECIAL INSPECTION
REQUIRED
JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINAL INSPECTION REQ'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
Plumbing
Base Fee
PLAN CHECK NO: VESTED DATE
Mechanical
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.
Grading
Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
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'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
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 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVY'REAP THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AMfTHE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY ]TH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AU HORIZqD THEREBY, NO PERSON WILL BE EMPLOYLD
IN VIOLATION OF THE LABOR CO E OF THE STATE OF WASHINGTON RELATING TO
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APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or hisitier Deputy: and Fees are p
, aid, and
FOR INSPECTION receipt is acknowledged in space provid I
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WORKMEN'S CO I ANCE,AND RCW 18.27.
MPENSATION 1
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771-0220 RE /ftb BY TFA7�
SIGNATURE (OWNER — .
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I DATE SPINED
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ATTENTION
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IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPE�CTOR
PANCY HAS BEEN GRANTED. UBC109/[BC110/IRC110.
09/03 PRESS HARD -YOU ARE
PINK - OWNER GOLD - ASSESSOR
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 ...................
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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