20040485.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
77
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NAME
ADDRESS
CITY
NAME
ADDRESS
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CITY
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STATE LICENSE NUMBER
.-dj I PROPERTY TAX ACCOUN
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
ZIP ITELEPHONE
ZIP TELEPHONE
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1:1
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
' OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK
fO 13E DONE
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PERMIT EXPIRES
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SUITE/APT#
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PLAT NAME/SUBD01SION
NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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7ESCP Approved E:
RW Permit Required E
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EXISTING
- PROPOSED
Street Use Permit Raq'd C
Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wiring required E
M M T
ETER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
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I A,
YES 0 NO bi
_.�5�UMBING / MECH
COMPLIANCE OR
El CHANGE OF USE
SIGN
FENCE
( x FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
SIGN AREA OYES ONO S HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
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REQUIRED SETBACKS (170 PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
REMARKS
CHECKED BY ITYP IJ T ON OCCUPANT .
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SPECIAL INSPECTi6N AREA OCCUPANT
REQUIRED LOAD
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D i�
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
ECK NO VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CIT-Y OF
I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
Al-L CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
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.4
X1 Recording Fee Receipt #
I Q
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVIAL'
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 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 011icial or his/her 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 COM P ENSAT?WMS� RANCE AND RCW 18.27.
OFFI S SIWTURE DATE
DATZES/NED
,81dNATU (OWNER,.2! GE (425)
I A
771-0220 R ED BY, DAITE.
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EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL &Ijx, 11271_�zl /,,v
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ILE - 4 CTOR
ORIGII AL-F YELL - I NJE.
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PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK -OWNER - GOLD -AS SSOR
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 ..........
PLUMBING:
Underground .............
fy\,s
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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