20040493.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINEAS1 -1 If
MAILING ADDREdS
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STATE LICENSE NUM ERI I
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PRO ERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
EGARAGE RETAININGWALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
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NUMBE�
NUMBER OF
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In RTnRIF. UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
PLAN CHECK
DATE I CHECKED BY
PLUMBING / MECH
COMPLIANCE OR
USE
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FIRE SPRINKLER
FIRE ALARM
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USE PERMIT
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NUMBER
JOB SUITE/APT it
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
LID FEE $
TESCP APP(OW00
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW permit Required
Street Lisa Permit Raq'd
inspection Required
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EXISTING PROPOSED --
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S,dewillk Required
OU IR DEDICIATION— FT
underground
wifing required
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ETER SIZE
M MF R
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO E3
REMARKS
OWNERICONTRACIOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
BY
DATE
DATE
SHORELINE OR ADBN INSPECTION I 13OND
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEM T ALLOWED PROPOSED ALL016VED PROPOSED
EXP IK
1 1 20—C
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED OPOSED FRON SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA 70�NNING RE OWD �Y DATE
REO'D DED 170,V0 149-k Zy '51� V/0
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REMARKS
CHECKEDBY jTYP2;0�C0.'RUCTIQN
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C RITICAL TION JAREA OCCUPANT
REAS SPECIAL INSPEC LOAD
UMBER REQUIRED
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 15
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 LIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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 1 HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMI\TION
GIVEN IS ��ORECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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ER
THE 0 ER. I GREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN ING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN /iOLATIO F THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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RKMEN'S MPENSAYON INVA�N E AND RCW 18.27.
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4IGNED /
12-16
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771 -0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt # .2� Ve-T
Total Amt. Due
Receipt 0
APPLICATION APPROWIL
This application is not a perrnit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
RELEA1$FD BY DAT
ATTENTION IZA 1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09!03 PRESS HARD -YOU ARE MAKING 4 COPIES
44
ORIGINAL - FILE YELLOW - INSPEC
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
FoWng.... ; .................
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
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OCCUPANCY ..................
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