20040569.pdfDATE RECEtED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Ic MAILING ADDRESS
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CITY
NAME
CITY
STATE LICENSE NUMBER
NEW
ADDITION
REMODEL
E] REPAIR
El DEMOLISH
GARAGE
CARPCI)RT
(TYPE OF USFt I
ZIP ITELEPHONE
ZIP I TELEPHONE
EXPIRATION DATE
[:] RESIDENTIAL
*COMMERCIAL
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GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
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EXPLAIN:
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PERMIT EXPIRES _LtLLLLJ-
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PERMIT
NUMBER
JOB
ADDRESS
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SUITE/APT#
PLAT NAME/SLIBDIVISION
NO.
LOT NO
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION- F1
TESCP Approved
RW Permit Required
Street Use Permit Floq'd
inspection Required
Sidewalk Required
Underground
Wiring required
13
E3
13
13
E3
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
10
ENGINEERING REVIEWED
BY
DATE
FIRE REVIEWED BY
DATE
CHECKED BY
PLUMBING / MECH
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COMPLIANCE OR
OF USE
CHANGE
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SIGN
1:1
FENCE
( X FT)
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OTHER
SPRINKLER
IFIRE
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FIRE ALARM
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VARIANCE OR CU HORELINE OR ADB# I INSPECTION I BOND
REO'D POSTED
13YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE I
REO'D I PROVIDED CL
REMARKS
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CHECKED BY OCCUPANT
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uu NUMBER NUMBER OF CRITICAL
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SPECIAL INSPECTION JAREA
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OCCUPANT
LOAD
0 STORIES UNITS NUMBER
REQUIRED
DESCRIBE WORK TO BE DONE i
REMARKS
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PROGRESS INSPECTIONS PER UBC 11081FINAL INSPECTION REQ'D
F3
:3
VALUATION
$
Description FEE Description FEE
Plan Check
State Surcharge
URCE GLAZING % LOT SLOPE %
Building Permit Z&�
City Surcharge �5
CK NO: VESTED DATE
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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LU PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in "APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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Fire Review
Plan Chk. Deposit
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_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcriy OR INDIRECTLY
71 FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Receipt #
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I ' 'E 13 y
' F'
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
6 'VEN
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
T' I E 0 WNI
CALL
This application is not a pefinit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TION - AN C
Building 011icial or his/her Deputy: and Fees are paid, and
IN Vi6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I V I OL 1
FOR INSPECTION
receipt is acknowledged in space provided
6NA
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFI IAI URE DATE
SIGNATA)RE (OWNER on AGENT) DATE SIGN
(425)
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771-0220
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RFLFA
ENTION
EXT 1333
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OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPEAR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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171
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ........... 0
0
Slab Insulation .......... M
PLUMBING:
Underground ............. x
M
C
Rough -In ................... M 0
0
0
Commercial Final ...... 0
C
HEATING: IT!
M z
Gas Test ....................
Gas Piping ................. -4
x
Equipment .................
0 _n
_n
Commercial Final .......
M ITI
EXTERIOR SHEATHING 0
NAILING .......................... 0
0 M
FRAMING ......................... C= CD
9 Cn
M 0
FIRST FLOOR FRAMING... Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation ....... Cn
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. lyt