20040570.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY
ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME
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AUDRESS
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CITY ZIP T LEPHONE
STATE LICENSE NUMBER EXPIRATION DATE CH
144
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
[-] RESIDENTIAL
ADDITION
'��OMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
rARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
uj NUMBER NUMBER OF
OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO
Y�E 11NE,7
7-1! 1 _7.el
— I -
HEAT SOURCE I GLAZING %
PERMIT EXPIRES
"I USE PERMIT "I
ZONE
NUMBER
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
ER SIGN
FENCE
I FT)
OTHER
EFIRE SPRINKLER
] FIRE ALARM
iki
I
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
all SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTIY OR INDIREC rLY
3: FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT BE
9 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
LD 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 AUTI IORIZED AGENT PF
JOB
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE NO. OF FIXTURES
le-1-1
LLL12-14
SUITE/APT#
LID NO.
LID FEE $
IESCP Approved
13
RW Permit Required
0
Street Use Permit Roq'd
E3
Inspection Required
E3
Sidewalk Required
E3
Underground
Wiring required
C3
PRV REQUIRED
YES 0 NO 0
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED By DATE
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION BOND
loyRE021 POSTED
ES AN S
01
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
f q
EXP X, Ll 6 �i, 1 ;1,5 lk Iq I I'
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA =E Y DATE a.
REO'D I PROVIDED
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REMARKS
CHECKED BY TYPE Of CONSTRUCTION CeDE OCCUPANT
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- - ly y
SPECIAL INSPECTION AREA OCCUPANT
R OU I LOAD
EQUIREDE] YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108)FINAL INSPECTION REQ'D
VALUATION
Description
FEE
Description
FEE_
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
bol
Fire Inspection
Receipt
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt
APPLICATION APPROVAL
Thi , fication is not a nLrmit until signed by the
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUc CALL Building Official or his/tier Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAff6W-09DE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27, 0 11C SIGNATI, RE DATE
SIGN Y7(,WNEFRIf GENT)/ DATE SIGNED (425)
DhTE I
771-022-0 AS D BY
ATTENTION EXT 1333
V
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCT �E UNTIL
T
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A ERTIFI- ORIGINAL - FILE YELLOW - NSPECA
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
YO U GREEN - ACCOUNTING
04/02 PRESS HARD -YOU E AKING 5 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
0
PLUMBING:
=n
Underground .............
--I
M
Rough -In ...................
M
0
Commercial Final ......
0 C
HEATING:
M M
M Z
Gas Test ....................
r) --I
C z
Gas Piping .................
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Equipment .................
0 _n
Commercial Final .......
EXTERIOR SHEATHING
M M
NAILING ..........................
0 U)
0 r-
FRAMING ........................
0 M
C: U)
FIRST FLOOR FRAMING ...
M 0
Z
7'
INSULATION ...................
Floor Insulation .........
>
Wall Insulation ...........
z
Ceiling Insulation .......
SHEETROCK NAILING ...
z
0
11
SPECIAL INSPECTION ...
5
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
9
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