20040534.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NAME
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CITY ZIP
NAME
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ADDRESS
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CITY
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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TELEPHONE
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EXPIRATION DATE
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PERMIT EXPIRES
USE PERMIT /I
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ADDRE 1E SUITE/APT#
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NOI
LID FEE $
IESCP Approvod
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street use Permit Roq'd
EXISTING - PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION� FT Underground
Witing required
EMETER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NEW
RESIDENTIAL
'�kPLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
11
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS El ( x FT)
DEMOLISH
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OTHER
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CARPORT
RETAINING WALL
FIRE SPRINKLER
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ROCKERY
FIRE ALARM
(TYPE OF USE. BUSINESS
OR ACTIVITY) EXPLAIN:
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NUMBER OF
CRITICAL
OF
DWELLING
AREAS
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UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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YES 11 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDIRAINAGE
Type B or 1. vent connectors
required on fuel -burning appliances IF
ENGINE
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE Oil ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FF.)
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
OCCUPANT
GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIREDE] LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D Fn
GAS PIPE TEST MUNI Ut
CHECKED BY ITYPE
VALUr-,_i ION AUIDAVITS SHAtt NOT—
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,,.r"j Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE 4640k
6,16 Building Permit City Surcharge
PLANCICHIEblK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CUREIS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION.
cc Engr. Review
uj PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit
(A Fire Review
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
M Fire Inspection Receipt #
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO IVIODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp.
Total Amt. Due tj
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1:1 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION - �1 I
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITI I 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/her 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 COMPENSATION INSURANCE AND RCW 18.27.
URF DATE
- IALS SIG A'
SIGNA URE (OWLyER_yAG,1�',7 DAtE S NED/ (425)
)7
771-02
1 20 RELWED BY DAfE
AtTtNTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
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 YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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 ........................
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fIRST RAMING ...
I-MSULAT16N ......
...........
Floor I'nsblation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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