20040571.pdfDATE RECEIVED `7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NUMBER
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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
[3
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EXISTING - PROPOSED
Street Use Permit Roq'd
Inspection Required
13
13
Sidewalk Required
[3
REQUIRED DEDICATION�
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Underground
wiring required
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METER SIZE
LINE SIZE
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NO. OF FIXTURES
PRV REQUIRED
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YES 11 NO 11
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL #
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1:1 SIGN
REPAIR
GRADING FENCE
CYDS ( X FT)
DEMOLISH
TANK
OTIP
GARAGE
CARPORT
RETAINING WALL
ROCKERY
E] FIRE SPRINKLER
FIRF: At ARM
(TYPE OF 4SE, BLISINESSjOR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
STORIES
DWELLING
AREAS
UNITS
NUMBER
DESCRIBE WORK TO BE DONE 1.16 le
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PLAN CHECK NO:
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VESTED DATE
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ALLOWED PROPOSED
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
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PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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SPECIAL INSPECTION JAREA L,1 OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081 IBC109 IRC109 FINAL INSPECTION REO'D I z
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4 VALUATION
$ 7
Description FEE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3
SEPARATE PERMISSION.
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Lu PERMIT APPLICATION: 160 DAYS
13. PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y 1*0 ENFORCE ANY ORDINANCE PROVISION.-
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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 9-OMPENSATION INSURANCE AND RCW 18.27.
6_1
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
552-
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU.
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
Description FEE
State Surcharge 4,SD
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due (0�510
Receipt #
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.
RELEASE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Stab 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
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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