20040536.pdfDATE SEC
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY
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NAME
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NAME
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ADDRESS
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2-5 77q
TELEPHONE
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STATE LICENSE NUMBER EXPIRATION D
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PROPERTY TAX ACCOUNT PARCEL NO.
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7^,) 1 Z::�2 �_CXD
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ADDITION
F-1 COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EGARAGE
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RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOJACE I GLAZING %
PLAO CHECK NO:
CBL #
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — X_
OTHER
BY
FT)
PERMIT EXPIRES
US9 PER
ZONE NUMBER-
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JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
'[3
IESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
P1W Permit Required
E3
Street Use Permit Roq'd
[3
EXISTING — PROPOSED
inspection Requifed
E3
Sidewalk Required
E3
REQUIRED DEDICATION— FT
Undarg(mind
Winng required
PRV REQUIRED
METER SIZE
LINE SIZE
NO. OF FIXTURES
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YES 13 NO 13
REMARKS
OWNERIC-Q-NTRACTOR RESPONSIBLE FOR EROSION CON7ROLiDRAINAGE
required *H fuel -burning applisinep-q
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eated spaces. UMC 815.1.7
ffv&.R� -.......-DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINEORADB# r-INSPECTION BOND
REO'D POSTED
10YES EINOIS
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
SIGN AREA HEIGHT
ALLOWED - PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR I FRONT LJR SIDE REAR
LOT AREA I PLANNING REVIEWED BY DATE
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FIRE SPRINKLER
FIRE ALARM
CHECKED BY ITY NST C' OCCUPAN�p
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AREAS SPECIAL INSPEC I AREA OCCUPANT
NUMBER REQUIR LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
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OBSERVED BY G11Y INSPH10K
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VALUATION A�FIUAVM% =Lt NOT
$ BE ACCEPP I ED
LOT SLOPE %
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: 180DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT. ON 13EHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
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W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
rr ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIF� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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01 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.*
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
41x
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt 0
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt 0
I I IERE13Y 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- 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/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27. OF0IQfALS SIGNATURE DATE
SIGN UBE (OWNER 9-AGEIIT) DATE SIgNED (425)
771-0220
4AN"Tt 0 mN EXT 1333
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
o9/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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SETBACKS ........................ . ..
FOUNDATION:
Footing .......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
VVI)
Gas Test .................... —
Gas Piping ................. — VV-) L)
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRS� FC60�'FRAMING ...
.1 �SULATION ...................
. 'j.eloo! Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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