20040501.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSIN S
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MAILING ADDRESS
7-7-151 t -
CITY ZIP TELEPHONE
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NAME
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CITY ZIP TELEPHONE
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NAME CBL rl
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ADDRESS
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CITY ZIP
TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
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PROPERTY TA)i ACCOUNT PARCEL NO.
(7
1
1:1 NEW
RESIDENTIAL
PLUMBING MECH
1:1 ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
5( REMODEL
El MULTIFAMILY
SIGN
GRADING
1:1 REPAIR 11
Ei FENCE
In, y nq X FT)
E] DEMOLISH El TANK
OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
ALARM
CARPORT ROCKERY
FIRE
OYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
tRITICAL
OF
DWELLING
A)
AREAS
/u/4----
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK N���� VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
W
CL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
in
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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< ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, ARISING OIAECTIY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
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-11 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
410 NOR LIMIT IN ANY WAY THE CITYS ABILITY 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 CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE R DE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT N INSU�ANCE AND RCW 18 27.
SIGIfURP-tuvii GENT)) DATE SIGNED
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USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER z`t,�
SUITE/APT#
f 171 (�'6/ I/ I/ -)
lit;i"
LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
METEf *ji[)t+jj;INjALEC til�l CIO "Peffflu
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103
LID NO.
LID FEE $
TESCP Approved
HW Permit Required
Street Use Permit Roq'd
Inspection Required
Sido�ritk Required
underground
YES
ENGINEE IIFVqg8FW%5W Of U IU VVLAIiOl OyatUlll
is open or closed, expansion tanks are
FIRE RE(IfeqUirfl(l. on all not water tanks perDATE
City Code. ECDC 19.30.020(c)
0
JIRED
NO
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1REO'D POSTED
0YES 11NOIS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS [FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR C3
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I I
REMARKS
CHECKED BY ITYPE
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108 / ISC109/ IRC109 FINAL INSPECTION RE'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
11;7,
Z-1
Base Fee �)
Plan Chk. Deposit
Receipt #
Total Amt. Due
-7
Receipt #
APPLICATION APPROVAL
I his application is riot a perinit until signed by the
Building Official or his/her Deputyi and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DA1 E
RFLEASFD BY DATE
ATTENTION t:)k I I jjj
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OFOCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRCI-10.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW - INSPECTOR
PINK � OWNER COLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION,
Footing .......
Wall ...........
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ............
PLUMBING:
Underground .............
Rgugh-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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