20040496.pdfI
DATE RECEIVED 4�_ "7 cl�,j PERMIT EXPIRES
USE P ERMIT
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CITY OF EDMONDS NUMBER Z,
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JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION I ADDRESS
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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PLAT NAMEISUBDIVISION NO LOT NO.
LID NO.
LID FEE S
TESGP Approved E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Roquirod 0
Street use Permit Roq'd E3
EXISTING - PROPOSED
Inspection Required 13
Sidewalk Requirad E3
REQUIRED DEDICATION- Fr
Unditigtound
Witing required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 1:1
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REMARKS
OWNERICONTRAClOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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INSPECTION
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BOND
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STATE LICENSE NUMBER EXPIRATION DATE
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SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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LOT COVERAGE
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REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
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COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
116
REMODEL MULTIFAMILY SIGN
REO'D I PROVIDED
GRADING Ei FENCE
REPAIR CYDS X FT)
REMARKS
DEMOLISH TANK El OTHER
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACIVITY) EXPLAIN-
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CHECKED BY ITYPE 0 CONSTRUCTION CODE OCCUPANT
GROUP '71
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SPECIAL INSPECTION OCCUPANT
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
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STORIES
UNITS
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NUMBER
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LOAD
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DESCRIBE WORK TO BE DONE _
REMARKS
PROGRESS INSPECTIONS PER UBC 108 IBC109 IRC109 FINAL INS PECTION REQ'D
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VALUATION
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HEAT SOURCE I GLAZING %
PLAN CHECK NO:
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 100 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIYOR INDIRECILY
FROM THE ISSUANCE OF THIS PERM11. ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CIMS ABILLIY 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 DU& AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITII CI1Y AND STATE LAWS REGULATING CONSTRUC-
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 TO
WORKMEN'S ��NSATION INSURANCE AND RCW 10 27.
SIG E WNE R AGE
DATE SIGNED
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
10
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp-
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
This application is no, a perinit until signed by the
Building Otticial or his/he; Deputy. and Fees are paid, and
FOR INSPECTION
(ecLipt is acknowledged in tpace provided.
OFFICIALS SIGNATURE DATE
(425)
771 -0220
'R E I F,<S EL- 6
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ATTENTION '7
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL ZQ
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- ORIGINAL ( FILE j YELLOW -INSPECTO
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - Ow� - GOLD - ASSESSOR
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 .............
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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