20040566.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED[
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PROPERTY TM ACCOUNT PARCEL NO.
00 1/ �J` 17 70 / cy"It , 1-/ 61
NEW
E] RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH TANK
GARAGE
RETAINING WALL
El
CARPORT
ROCKERY
(rYPE OF USE,
BUSINESS OR ACTIVIM EXPLAIN:
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NUMBER
NUMBER OF
OF
DWELLII� G
STORIES
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DESCRIBE WORK TO BE DONE
PLUMBING / MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
FT
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OTHER
SPRINKLER
EFIRE
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FIRE ALARM
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB SUIT4E1APTA_
ADDRESS )
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
I ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
street use Permit Roq'd
EXISTING - PROPOSED inspection Required
Sidewalk Required
Underground
REQUIRED DEDICATION- FT Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I � YES 11 NO IJ
IREMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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FIRE REVI BY DATE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REQ'D POSTED
��2� NOIS
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED_, PROPOSED ALLOWED SED
EXP V-40, + PROPO
LOT COVERAGE REQUIRED SFT13ACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
45�7rj 15, /5 1 7
PARK17NG L( PLANNING REVIEWED BY DATE
REQ'D I PROVII ED
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REMARKS
CHECKED BY I YMzF,� 0
CRITICAL i yj T;�> 1� g
AREAS . 1,4,� SPECIAL INSPECTION JAREA
NUMBER.69__&E� I REQUIRED [] YES
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REMARKS
PROGRESS INSPECTIONS PER ILIBC I 08/FINAL INSPECTION REQ'D
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PLAN CHE�C�N,,O'.
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.
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PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
to
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC1 LY
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FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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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 Co��NSATION IN URANCE AND RCW 18,27.
SIGN TUR)E 6WNEI��R AGENT)
DATE
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/ALUATION
Description
F EEE
Description
FEE
:Ilan Check
State Surcharge
3uilding Permit
15 C,
City Surcharge
3lumbing
Vlechanical
Srading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
OF/6ALS SIGNPTURE OATE
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kE'iEASED BY U/% I t
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(AT E I ION
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
M3
Pier/Porch .................
Retaining Wall ...........
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 NIS
OCCUPANCY ..................
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