20040544 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME L N
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ADDRESS
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CITY TELEPHONE
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STATE LICENSE NUMBER EXP71RAT 0 = DATE 1,,JHECKE"Y
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IROPERTY TAX ACCOUNT PARCEL NO
NEW
RESIDENTIAL
El
PLUMBING if MECH
ADDITION
COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
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SIGN
REPAIR
GRADING
CYDS
E:i
FENCE
( x FT)
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BF, DONE
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HEAT SOURCE GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOHS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMt ESS THE CITY OF
I EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTIY OR INDIREC1 LY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMIT SHALL NOT BE
a DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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 LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI RANCE AND RCW 18 27.
SIGNATVPE (OWNE9 OR-AGEN-TY' DATE 51GNEC�
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
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JOB SUITEIAPT#
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ADDRESS / 0 2- S I
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO� I
LID FEE $
TIESCP Approved
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
[3
street use Paired Roq'd
0
EXISTING — PROPOSED
Inspection Requited
C3
f
sidewalk Requited
REQUIRED DEDICATION— FT
underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES 11 NO 13
REMARKS
OWNER/CONTRAcroR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
PURSUANT TO UPC 605.2
AWA..,
-TER SERVieE snu
SHALL BE INSTALLED ON T=
THE BUrLDIN(3
ENGINEERING REVI
FIRE REVIEWED BY
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PROGRESS INSPECTIONS Pp UBC 108/IBC109/IRC109 FINALINSPECTION REO'D F3
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VALUATION --0 li� 6 0 Jbki—
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
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City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
rhis application is riot a permit Until Signed by the
CALL Building ollicial or his/her Dopulyi and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided
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IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINAL PROJECT APPROVAL FORM
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DATE.
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
..FROM: FIRE DEPARTMENT DATE.-
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ............. ........ ..
Footing ......................
'WA I .......... ........
�'Pi&/Porch, .... ......
Retaining
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
OCCUPANCY ..................
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