20040576.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE E/NAME OF BUSINE
MU MAILING ADDRESS
k�5 C.,
CITY
411
NAME
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P: ADDRESS
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CITY
NAME
ZIP
ITELEPHONE
(4 ziii,
ZIP TELEPHONE
17BL M
ADDRESS
'�`u U Ice T—
CITY ZIP
STATE I ICENSE NUMBER
JOB
ADDRESS, t-70-1c." LAIC)CC Ltm
PLAT NAME]SUBDIVISION NO LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO� OF FIXTURES
PERMIT EXPIRES
PERMIT
NUMBER
3 7
SUITE/APT#b
M
LID NO.
LID FEE $
TESCP Approved 13
AW Permit Requited 13
Street Use Permit Roq'd 13
Inspection Required [3
Sidewalk Required E3
underground
wiring required 13
PRV REQUIRED
YES 0 NO 1:3
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLMRAINAGE
ENGINEER1114GREVIEWIEUBY 1U 13C L�tDA7Eii-'
0 !31DF_ SEWER NIUST RE CAPPED AT
77077,FfY LINE
FI E REVIEWE DATE
TELEPHONE
P
OR
F
N
IR
GIN
E
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTI t AL
ADDITION
El
��Co MMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
�5��DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(rYPE-OR USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
TION DATE
(5 WA.Tr,-j:, ME
IT-,R. TO BE RFMOVE
V 1
ARIANCE OR
Y
1 0
SEPA REVIEW
COMPLETE ENW
06 -Ok= XP 61 CHEC
J�EXP
PLUMBING MECH LOT COVERAllf"
ALLOWED PROPOSED
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
FT'
I — x
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL Mv
AREAS
NUMBER
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
I I
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.
2
Lu PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
'Cl SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, IIS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC11Y Oil INDlRFCItY
x FROM THE ISSUANCE OF I HIS PERMIT ISSUANCE OF I Ills PERMIT SHAI, I NOT FIF
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICA1 ION, THAT THE INFORMATION
GIVEN IS CORREC� AND THAT T IE OWl' ER. OR THE DUIY AUTHORIZED AGENT OF
THE OWNER _AWS REGULA
I� IDA E TO COM WITH CITY q4D STATE L ING CONsrRuc
THAT I
COM
TION, AND G 111E / UTHORIZE L BE EMPLOYED
0 k WO t q1,1EREBY. NO PERSON WIL
B
IN VIOLATION THE LAB R ODE OF 11 TATE OF WASHINGTON RELATING TO
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WORKMEN'S C PENSATI .1 SURANCE RCW 18 27
NER A/ N
SIGNIJE t(
DAL E /S;!
3t� ��� I " 1
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY
SILORI&Al! M AMil I Wpk BOND
REO" POSTED
AT Al JIDMA100h . OrqLy
SIGN ARE HEIGHT
Fj%WtrWj r+O bijjW',('j�hQNWED PROPOSED
LIST ON 13ACK O'ij.1013 CA D
0111TRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
SPECIAL INSPECTION JAREA
REQUIRED
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
M
0
z
2
z
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/ IRC109 FINAL INSPECTION REQ'D
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
16-
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
I Ills application is not a permit until signed by the
Building 011icial or his/her Deputy. and Fees are paid, and
x6pt is picknowledged in space provided
rL
4AE'
OFFICIAI[IBIG4NJILIRE T
RIFT F . ASft) 13Y DATE
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL L
INSPECTION HAS BEEN MADEAND APPROVALORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/iBC11011IRCIIO.
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
OHIGINAL FILE YELLOW - INSPECTOR
PINK OWNER GOLD - ASSESSOn
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
z
0
Pier/Porch .................
I
0
M
Retaining Wall ...........
Slab Insulation
=n
--I
PLUMBING:
1711
C
M 0
Underground .............
0
0
0
Rough -In .. ... ............. ;.
C
--I
3: M
Commercial. Final � ......
ITI Z
.,H,EATING:,
C
> z
Gas Test ....................
Gas Piping .................
0 -n
-n
Equipment .................
3:
M M
Commercial Final .......
0
0
0 M
EXTERIOR SHEATHING
C Cn
NAILING ..........................
90)
M 0
Z
FRAMING ........................
I
FIRST FLOOR FRAMING ...
;U
3:
INSULATION ...................
>
z
Floor Insulation .........
--I
Wall Insulation ...........
z
0
Ceiling Insulation .......
--I
0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
c)
OCCUPANCY ..................
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