20040508.pdf(7 '01
DATE RECEIVED
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
TELEPHONE
PERMIT EXPIRES
USE PERMIT
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NUMBER
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ADDRESS
NAME
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TELEPHONE
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STATE i - -1 SE NUMBER EXPIRATION DATE
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CqCKEDqY
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PROPERTY TAX ACCOUNT PARCEL NO.
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14 NEW
RESIDENTIAL
PLUMBING / MECH
1:1 ADDITION
COMPLIANCE OR
El CHANGE OF USE
11 REMODEL
-�..COMMERCIAL
MULTIFAMILY
SIGN
1:1 REPAIR
GRADING FENCE X
CYDS Fr)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. B
INESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
I DESCRIBE WORK TO BE DONE
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PLAT NAME/SUBDIVISION NO I ILOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITEi'APT#
LID NO.
LID FEE $
I ESCP Appro-Od
RW Permit Required
Street use Permit Roq'd
Inspection Required
Sidewalk Required
underground
Wiring required
PRV REQUIRED
YES El NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: &'� (q 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: ISO DAYS
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IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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�I IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
4
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY I HE CITY'S ABIL11Y 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 LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN SA901444SU RANCE AND RCW 18.27,
SIGNATURE (OWNER,10;AGENY DATE SIGNED
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REMARKS
CHECKED BY ITYPE
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SHORELINE OR ADBP
INSPECTION
BOND
REQ'D
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SIGN AREA
HEIGHT
ALLOWED PRO POSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
FRONT SIDE REAR
FRONT URSIDE REAR
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LOT AREA
I PMNING REVIEWED,6Y. DATE
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SPECIAL INSPECTION JAREA
REQUIRED C] YES I
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108 / IBC109 / IRC1 09 FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
)0 State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This 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.
,��IALS SIGNATURE DATE
9ASFD BY�
ATTENTION t:)kl ljjj (_ / /A
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL Vz
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
CALL
FOR INSPECTION
(425)
771-0220
ORIGINAL - FILE YELLOW - INSPECTO
PINK - OWNER GOLD - ASSESSOR
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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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