20040498.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINE
MAILING ADDRESS
CITY
NAME
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ADDRESS
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CITY
NAME
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ADDRESS
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Ir-
CITY
STATE LICENSE NUMBER
6 �5 ( Wj � �
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
0 GARAGE
CARPORT
I[TYPE OF USE, I
ZIP
ZIP
ZIP
15z�4 /
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
7;�
I PERMIT EXPIRES
PERMIT 1_? ok
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NUMBER /,G�)j—
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ADDRESS ow D
PAO,(
PLAT NAMEiSUBDIVISION NO.
LOT NO.
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SUITE/APT#
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LID NO.
LID FEE $
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
BW Permit Required
13
Dr 1
Street Use Permit Raq-d
0
TELEPHONE EXISTING - PROPOSED
Inspection Required
Sidowalk Required
Q
E3
REQUIRED DEDICATION- FT
Undargrotind
Wiring roquirod
13
TELEPHONE
TELEPHONE
EXPIRATION DATE CHECY;fD BY
/';)//9Z""-_J/T`W
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
NUMBER 09BER OF
OF WELLING
STORIES FNITS
DESCRIBE WORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
EiFENCE
( X FT
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGItal
VARIANCE OR
ST MUST BE DATE
ITS SHALL NOT
vgig-
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
ADBO INSPECTION BOND
RE,
OYES
REO'D POSTED
OYES 0NO IS
SIGN AREA HEIGHT
ALLOWED . PROPOSED ALLOWED , PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DAI E
REQ-D I PROVIDED I
REMARKS
CHECKED BY ITYPE
OCCUPANT
GROUP
HnAkIT
SPECIAL INSPECTION JAREA U��
REQUIRED LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D -
M
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge i5�
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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 CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALI. CLAIMS FOR DAMAGES OF WHATEVER NAIURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
CI DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
-A
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
—
Receipt #
X1
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAL
GIVEN IS CORRECT� AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY Willi CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a permit until signed by the
d 011' ' I his/tier Deputy: and Fees are paid, and
Ing
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION
rec:1311�11soarck ILdged in space provided.,,
WORKMEN'S COMPENSATION��URANCE AND RCW 18.27.
OFF]
I S SIGNAIU 1) TE
SIGNATURE GFNrr-, DATE SIGNED
,4eWNE"
(425)
771-0220
BY DAT
-1
ASED
OT-EfiTION
EXT 1333
IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
L
IT
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL FILE YELLOW INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
PINK -OWNER 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:
17-
Gas Test ....................
Gas Piping ................. -7,1
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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