20040486.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINF S
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MAILING ADDRESS
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TAX ACCOUNT
-70
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NEW
RESIDENTIAL
111MM / A�MECH
ADDITION
COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
E] CYDS
FENCE
El ( X FT)
DEMOLISH
E] TANK
OTHER
GARAGE
E:] RETAININGWALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
I[TYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAIJN:
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NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS /V
CRITICAL
AREAS
NUMBER A)
DESCRIBE WORK TO BE DONE
11�
GLAZING %
PLAN CHECK NO:
7_i:�
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.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NA1 URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMI1 SHALL NOT HE
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY 1 HE CITY's ABILI rY 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 Cn AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHOPIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION 0 OF WASHINGTON RELATING TO
,��Fi,AQQP_CODEPF THE STATE
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WORKMEN'S PENSPM�k�l S)R�ICE AND RCW 1&27.
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ADDRESS
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PLAT NAME/SUBDIVISION NO
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PERMIT EXPIRES
PERMIT
NUMBER
SUITE!APT#
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LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
RW Permit Required
Stroot Use Permit Roq'd
Inspection Required
sidewalk Required
Underground
Yviring required
PRV REQUIRED
YES 1:1 NO El
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADS# I INSPECTION -BOND
------ REQ_Vr POSTED
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EK ALLOWED PROPOSED ALLOWED PRO�OSED
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LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA I Pl� RE� DATI��
171
REO'D I PROVIDED IL
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REMARKS
CHECKED BY
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OCCUPANT
=CONSTRUCTION
GROUP
SPECIAL INSPECTION JAREA
OCCUPANT
REQUIRED [] YES
LOAD
REMARKS
C5
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
$
Description
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
FEE
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a perinit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged if, space provided.
OFFICIALS SIGNATURE DArE
RFLFA�ED BY� IDATE(
L
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L;
ATTENUON EXT 1333
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
44IGINAL - FILI� YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD —YOU ARE MAKING 4 COPIES I/
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch .................
0
Retaining Wall ........... 171
Slab Insulation ..........
PLUMBING:
M
Underground ............. M 0
0
0
Rough -In ................... 0 C
Commercial Final ...... :E M
M Z
JO —1
HEATING: C
>
GasTest ....................
Gas Piping ................. 0 -n
-n
Equipment.................
x
Commercial Final ....... M
0
0
EXTERIOR SHEATHING 0 M
C
NAILING .......................... Cn
Q 0
FRAMING ........................ 1
Z
FIRST FLOOR FRAMING ... ;U
--I
INSULATION ................... M
>
z
Floor Insulation .........
--I
Wall Insulation ...........
Cn
z
Ceiling Insulation .......
0
SHEETROCK NAILING ...
171
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR ZD —
OCCUPANCY ..................