20040530.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
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PERMIT
NUMBER
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICAIION_ F1
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITE/APT# X'
LID NO
LID FEE $
TESGP Approved
Hw Permit Rore;irod
Street Uso Permit Roq'd
Inspection Required
Sidewalk Required
Undelground
Witing requead
PRV REQUIRED
YES 1:1 NO 1:1
REMARKS
OWNERICONTRACT013 RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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1-11 J%.- L L, L11 FIRE REVIEWED BY DATE
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VARIANCE OR CU HORELINE OR ADB# INSPECTION BOND
S E LICENSE NUM EXPIRATIO CHECKED Y REO D POSTED
LLSEPA REVIEW SIGN AREA YES ONO S HEIGH - T
ALLOWED
j PROP TY TAX ACCOUP[r PARCEL NO COMPLETE EXEMPT PROPOSED ALLOWED , PROPOSED
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NEW RESIDENTIAL PLU I MBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR
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ADDITION OMMERCIAL 2
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X—C PARKING LOT AREA PLANNING REVIEWED BY DATE
El REMODEL 1:1 MULTIFAMILY SIGN REQ'D PROVIDED a.
GRADING FENCE
1:1 REPAIR El CYDS 11 X FT) REMARKS
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M DEMOLISH F-1 TANK oAqwzw5a,�55 .
[3 GARAGE RETAINING WALL FIRE SPRINKLER
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CTYPE OF USE, BUSINESS rA T MVI XPL�l CHECKED BY JR OF CONSTRUCTION 'CODE OCCUPANT
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OF DWELLING AREAS SPECIAL INSRSCTION AREA OCCUPANT
LOAD
01 STORIES UNITS NUMBER REQUIRED [:] YES
DESCRIBE WORK TO BE DONE REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
Description FEE Description FEE
Plan Check CZ State Surcharge
HEAT LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee —
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WOR S PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review 'i Plan Chk. Deposit
'APPI ICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
to IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS. WASHINGTON, ITS OFFICIALS, EMPtOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREc rLy OR INDIRFCTIY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CIrYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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J1 - Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL I his application is not a ponnit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Olficial or his/her Depuly: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 pro I vided.
WORKMEN'S COMPENSATION INSURANCE AND RCW IH 27. R GNATL _ D T
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SIGNATUR (425)
(OWNER OR%A.PPT) DATE SIGNED
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771-0220( D TE
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By / 7L
WT_f0N EXT 1333
ATTE ? 7
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ffh(_1e1(_
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE - YELLOW -iINSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109 PINK OWNEP - GOLD - ASSESSOR
09 03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
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0
Slab Insulation ..........
0
PLUMBING: M
Underground .............
I -n
Rough -in ...................
0 M
I Final ...... C:
Commercia M 0
0
0
HEATING: 0 C
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Gas Test .................... X M
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Gas Piping ................. JO
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Equipment .................
Commercial Final ....... 0 -n
EXTERIOR SHEATHING
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NAILING .......................... x
M M
FRAMING ........................ 0
0
0 M
FIRST FLOOR FRAMING... C cf)
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M 0
INSULATION ................... Z
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Floor Insulation .........
Wall Insulation ........... M
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Ceiling insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
R069..,05201