20040575.pdfPERMIT EXPIRES
USE PERMIT
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NUMBER tLA
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JOB
SUITE/APT#
ADDRESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP App(ovittl
RW Permit Required
0
E3
Street use Permit Raq'd
[3
EXISTING — PROPOSED
Inspectian Requited
Sidewalk Required
13
E3
REQUIRED DEDICATION— FT
Undergiound
Wiring required
13
MEIER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
0 NTREET Tn ni,. el -
ENGINEERING REVIEWED BY �) 71;
SIDE SEWER MUST SE, CAPPED AT
FIRE REVIEWED By DATE
0 WATER METER TO BE REmaum
Lift
q - 21r, Z�) run ull-rw - Al �6 'LJ 13OND
CE OR CU SHORELINE OR ADBW ' _INV�dT%
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY DU P AT APPROVE REO'D POSTED
I QYNMN(STE ONLY
SEPA REVIEbEE HEIGHT
COMPLETE x _P1NW1V9PAMPdCTd03t4ED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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EXP FOR
NEW
RESIDENTIAL
PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
ADDITION
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COMPLIANCE OR
CHANGE OF USE
PARKING
REMODEL
MULTIFAMILY
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SIGN
REQ'D
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REPAIR
GRADING
rynS
FENCE
( X FT)
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
El
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USErflQ51,NESj/,07
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ACTIVITY1 EXTLAIN- tf
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CHECKED BY
NUMBER,,," ,W j
I NUMBER PF CRITICALIM V,11VT,
OF DWELLING AR V
STORIES UNITS "_ �__ I NUMBER'jq /Ir I
I DESCRIBE WORK TO BE DONE
I mrmz-& (Imclii I
GLAZING %
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
9 DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
q IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, I FS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
FROM THE ISSUANCE OF VHIS PERMIT. ISSUANCE OF THIS PERMIT SHALT. NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION
GIVEN IS CORRECT. AND 7HArI I AM THE OW R, OR THE DULY AUTHORIZED AGENT OF
THE OWNER
I� I Y,
.21EE TO C9 I.Y WITH CI No STATE LAWS REGULATING CONSTRUC-
TION, AND G THE �(O AUTHORI THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIONY51F THEtEl CODE OF iE STATE OF WASHINGTON RELATING TO
of� 1, g C
WORKMEN'S OMPENS 10 INSURAN ND RCW 18 27.
SIGNATURE OWNER 1191A' DATE SITE
1, D
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS f
CITY ZIP TELEPHOr,IE
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NAME
ADDRESS
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CITY ELE-PH;QNE
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NAME CBL #1
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ZIP TELEPHONE
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT L/R SIDE REAR
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OCCUPANT
GROUP
SPECIAL INSPECTION AREA LOAD
REQUIRED [] YES OCCUPANT
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PROGRESS INSPECTIONS PER LIBC 108 / IBC109 / IRC109 FINAL INSPECTION REQ'D_ 25
VALUATION
Description
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt it
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APPLICATION APPROVAL
Rusa iication is not a nerinit until signed by the
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CALL Building Official or titsitier Deputy. and Fees art, paid, and
FOR INSPECTION recept is acknowledged in space provided
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orFICIA:S I AT 11 DATE
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(40
771-0220 M11:1TAF1 314- DATq
ATTE TIO C;A I 1%3%3%J
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Pe rmit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
0111GINAL-FILE YELLOW -INSPECTOR
PINK OWNER GOLO-ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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 ...
Pa — &Lqo
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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