20040518.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS \J,JE
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
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ADDRESS
CITY
NAME
ADDRESS
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CITY
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STATE LICENSE NUMBER
_5-
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TELEPHONE
Cat. 4
ZIP TELEPHONE
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EXPIRATION DATE
ol 11 16 .- /
NEW
RESIDENTIAL
ADDITION
a -COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EGARAGE
I
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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M-
210LUMBING / MECH
COMPLIANCE OR
F-1 CHANGE OF USE
El SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
USE
ZONE
JOB
ADDRESS
V;Z;L:t;�j
PLAT NAM
PERMIT EXPIRES L4ZX--:-�
PERMiT
NUM-BER
SUITE/APT#
r,�Z-q A\
SION NO. LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING -_ PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO
LID FEE $
I ESCP APP(Ov
Fnv Permit Required
street use Perm', R oq'd
InspO010" RoqjIlled
S,de�.111, Hurlulft'd
ue,jergrotind
Wiring feritgred_
pRV REQUIRED
YES [:] NO 0
REMARKS
OWN ER/CO N TRACTOR RESPONSIBLE FOR EROSION CONTRO.L/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
1-� I
SEPA REVIEW
COMPLETE EXEIPT
EXP I )�-
LOT COVERAGE
ALLOWED PROPOSED
T�
PARKING
REQ'D I PROVIDED
NUMBER NUM6ER OF CRITICAL
OF DWELLING AREAS
STORIES 4 1 UNITS NUMBER
DESCRIBE WORK TO BE 00N�E I
0-1 �- �, I
REMARKS
CHECKED BY
DATE
DATE
SHORELINE OBADfP>jI INSPECTIONJ BOIND
u
[ oy R IE' POSTED
S 0 S
3YES NO S
SIGWAREA HEIGHT
ALLOWED - PROPOSED ALLOWED . PROPOSED
REQUIRED SETBACKS (Fr.) ! PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LJR SIDE REAR
-------------
LOT AREA I PjW
SPECIAL INSPECTION JAREA
REQUIRED C] YES
111
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER LIBC 1108/171NAL INSPECTION REQQ`D
(%I= -T-H T-- V_� T>,Us
HEAT SOURCE
GLAZING %
LOT SLOPE %
4��:� XC
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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 100DAYS
W
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT. 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 DIRECTI-Y OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOI 13F
DEEMED TO MODIFI� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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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 I-AWS REGULATING CONSTRUC.
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN V61-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
(OWN OVRENt
DATE SIGNED
USIA�tURE
JALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
FEE Description
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
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Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt # vdl-
APPLICATION APPROVAL
This application is not a pefinit until signed by the
Building Official or tits/tier Deputy:and Fees are paid, and
receipt isacknowledged in space provided,
OFFICIALS SIGNATURE D%T
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RFIFAUD BY
ATTENTION M,& 1
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YEI_LOW-INSPECT�
PINK OWNER GOLD -ASSESSOR
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(00*)
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRSTFLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
—Lai-
OCCUPANCY ..................
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