20040519.pdfDATE RECEIVED (
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CONER NAME/NAME OF BUSINESS
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NAME
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PERMIT
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LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET
TESCP Approved
13
MAP
MW Permit Required
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EXISTING
Street Use Permit Rart'd
13
� PROPOSED
inspection Required
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Sidewalk Required
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REQUIRED DEDICATION� FT
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Wiring required
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METER SIZE
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PRV REQUIRED
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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DATE
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CITY FIRE REVIEWED BY
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
'D POSTED
PROPERTY TAX ACCOUNT PARCEL NO-. SEPA REVIEW SIGN AREA Y E S 110:11 NO S HEIGHT'
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
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NEW ��RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ADDITION COMMERCIAL Ei COMPLIANCE 08 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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CHANGE OF USE 2
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REMODEL MULTIFAMILY SIGN REO PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REPAIR GRADING FENCE
_&_�7 —_ CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER O.Al- 6)APrr P-.5 f �s
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
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VALUATION
Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge
Building Permit city Surcharge C
PLAN CHECK NO: VESTED DA—TE
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 .................
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS ---------
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTERE�T, AGREES TO INDEMNIF'� DEFEND AND HOLD HARMLESS THE CIrY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
< ALL CLAIMS FOR DAMAGES OF WHATEVER NAruRE. ARISING DIRECTLY OR INDIREC FLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Amt. -Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
0. 7E,
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 WP`PLICATI_0N APAROtl_
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a Permit until signed by the
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/hot Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space Provided.
WORKMEN'S C��NSATION INSURANCE AND RCW 18.27.
SIGNATORfipNIE I OR AGEND__;;�; DATE SIGNED OFFICIALS IGN TURE ATE
(425)
771-0220 RELEASED BY
DAT
ATTENTIO"N E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. ORIGINAL -FILE YELLOW- INSPECTOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES 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 Vv 1 -7
OCCUPANCY ..................
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