20040499.pdfDATE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
W I L te-Ot.- �'_ I q L4 aO 12 /10 /0_5�
PROPERTY TAX ACCOUNT —PARCEL NO
PERMIT EXPIRES ZjC�Zqf`
USE PERMIT
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NUMBER
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ADDRESS ;2Lj7-2�]
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PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO,
LID FEE S
TESCP Approved
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
Slicer Use Permit Roq'd
E3
EXISTING - PROPOSED
inspection Required
Sidewalk Required
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13
REQUIRED DEDICATION- Fr
Underground
Wining required
13
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO NO 13
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REMARKS
OWNER/CONTRACt9jqj@E"j:�j af!!�E�o
fitMNI-IDRAINAGE
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unnn RIB ITHAVB INSTALLED
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IFIRE REVIEEV@) BDUMp AT AppROVIRD DUMP gM ON7
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X Fr]
DEMOLISH
TANK
OTHER
GARAGE
E:i RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS Cffl,�CTIVI N:
TP FLN
NUMBER
NUMBER OF
CRITICAL
OF
STORIES
DWELLING
UNITS
AREAS eN�
NUMBER
DESCRIBE WORK TO BE DONE
AA
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HEAT SOURCE I GLAZING %
LOT SLOPE %
VARIANCE OR CU
0
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
INSPEMON RfM
SIGN AREA
ALLOWED . PROPOSED
HEIGHT
ALLOWED . PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR I FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
_� I SPECIAL. INSPECTION I AREA
2AREQUIRED [] YES I
PLAN CHECK NO: 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 (CUREIS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: I 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 NAIURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAI L NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITTS ABILITY 10 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 CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAB_QK-CqDE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT)dN INSUNANCE AND RCW 18 27.
NED
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DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
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PROGRESS INSPECT1ONS PER UBC 108 1 IBC109/ IRC109 FINAL INSPECTION _ �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
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771-0220 RFIJFASED BY
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ATT-ENTItM
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- 0131GINAL - FILE YELLOW - INSPECTOR
f-_0AP,lTf=n HAC1091IBC110/IRC110. PINK - OWNER GOLD - ASSESSOR
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09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
L4 Lei
Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS fIGNA1 UPE DATE,
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DATE: REVISED:
SHEE. I NO.: mmm mm NEW [BUILLINS POR DRAWN:
PLOT PLAN 1iI%a4E L F RC F E FR T I E 5, L L CHECKED: UrL
W A R � �N L A F 0 N JOB NO.:
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I FINAL PROJECT APPROVAL FORM
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DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DMSION
YROM: FIRE DEPARTIMM DATE ----
ENGINEERING DIVISION DA17E
PLANNING DIVISION DATEL_____�
PROJECT
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SrrE ADMUSS LN 4E t V I - t i DAMINSPECTED
PERMrr ADB t__�
DESCRIPTION OF WORK TO -BE INSPECT. -
A field inspection was conducted to determine final compliance with.approved plans. Mmal approval
denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
I
GRANT PRojEcr APPROVAL wrrH CONDrrIONS NOTED
0 Copy of COMMONS given to Owner/contractor by'nspector
FAILED FINAL INSpEMON - OUTSTANDING ISSUES
a Copy of CORRECMON NOTICE given to owner/contractor by inspector.
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R.E_]NSpECTF,D OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL -
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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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