20040563 (2).pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITELE-PHONE
NAME
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ZIP
NAME
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ADDRESS
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CITY
TELEPHONE
ELEPHONE
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ZIP
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESID IAL
77
ADDITION
[D,-'COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLING
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STORIES t
UNITS
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DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING %
KPLUMBING/MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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LOT SLOPE %
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EXPIRES
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PERMIT �
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NUMBER
JOB
ADDRESS
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
EXISTING - PROPOSED
inspection Required
sidewalk Requited
REQUIRED DEDICATION-
FT
Underground
Wiring required
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES 13 NO 11
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP ��4
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
1
DATE
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SIGN AREA
HEIGHT
ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR
FRONT URSIDE REAR
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LOT AREA
PLANNING REVIEWED BY DKTE
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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],PROGRESS INSPECTIONS PER UBC 108 if IBC1 09 IRC1 09 FINAL INSPECTION REQ'D I i�
PLAN CHECK NO' 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: 180 DAYS
PERMIT LIMIT' 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECILY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL N01 BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CI1YS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.*
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
1 4
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt III
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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- CALL I Iris application is not a perinil until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 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 COMPENSATI 29KUR�NCE AND RCW 18,27. OFFICIALS SIGNATURE DAT
NATURE (OWNER OR T) D E SIGNED (425)
S 7-1
S14'. L,'� 0, J 771-0220 REL SE BY TE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL 0
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW-UPECTO11
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPI
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
z
Pier/Porch .................
0
--I
0
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
M
Underground .............
0
0
—40
Rough -In ...................
0 C
--I
Commercial Final ......
M
ITI z
HEATING:
C z
Gas Test ....................
Gas Piping .................
0 -n
n
Equipment .................
—1
Commercial Final .......
M M
0 C-1)
0 r—
EXTERIOR SHEATHING
0 M
NAILING ..........................
C: W
9 C/)
FRAMING ........................
Q 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
x
Floor Insulation .........
z
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Wall Insulation ...........
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
02 0011, 0 M3 V/