20040577.pdfDATE RECEIVED
7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEP'HbNE
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NAME BL#
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ZIP
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STATE LICENSE NUMBER
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EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO
020- 37(cl_ 6cif - Z Ack.�
NEW
RESIDENTIAL
PLUMBING MECH
ADDITION
�60MMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS ( X� FT,
DEMOLISH
TANK
OTHER
GARAGE
rARPQRT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
rrypE��USE. BUSINESS 06-ACTiVITY) EXPLAIN
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
Is
HEAT SOURCE
k�;T)L_)111
GLAZING %
CRITICAL
AREAS
NUMBER
LOT SLOPE %
PERMITEXPIRES
S E PERMIT
ZONE
NUMBER
JOB
ADDRESS
SUITE/APT
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved
RW Permit Required
13
Street Use Permit Roq1d 13
EXISTING - PROPOSED
inspection Required
Sidewalk Required
13
[3
REQUIRED DEDICATION- FT
Underground
Wiring required
[3
METER SIZE
LINE SIZE
OF FlInITURIS
PRV REQUIRED
FNO.
YES NO
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REMARKS
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OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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11 rRE-INSPECTION REQuIRED
STREET TO BE CLEANED OF ppngf_q
ENGINEERINGWVI DATE
PYSEWER MUST BE CAPPED AT
PROPERTY LIN13
FIRE REVIEVQD BWATER METER TO 13B DATE
REMOVED OR
HOSE BIB WITH AV13 INSTALLFn
VARIANCE 7 CUL) PHWf INWWE
INSPECTION BOND
Dtll S TE okff(3
S TY) oYES NOIIS
SEPA GEVI LCTION HEIGHT
�C Ifk0M§ER) PROPOSED
COMPLETE E f ff!rPT
RR INSPEC11c'! Af D
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED I
REMARKS
I-r7PE,OF
CHECKED BY RtTION
OCCUPANT
GROUP
SPECIAL INSPECTION JAAREA OCCUPANT
REQUIRED C] YES LOAD
AREMARKS
PROGRESS INSPECTIONS PER UBC 1 o8/ IBC109/ IRC109 FINAL INSPECTION REQ'D
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPIOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIr. ISSUANCE OF IHIS PERMIT SHALL NOT HE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI1Y ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILIIY TO ENFORCE ANY ORDINANCE PROVISION -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS RRECT�AND THAT I, M T IE OWNER Oil THE DU& AUTHORIZED AGENT OF
I A61 E
THE OWNE�Ro To COMPL WIIII CITY AND STATE LAWS REGULATING CONSTALIC
TION; AND IN DO" THE WOAK UT110HIZED THEREBY. N PERSON WILL BE EMPLOYED
IN VIOLATION 0 F IIE LAP,613 ODE OF XI? STATE OF WASHINGTON RELATING TO
WORKMEN'S CO �SATPN I 'URANcYA�611CW 18 27, 1 1
IE
SIGNATt71,i;t1OER OtG E
DATE/
j!GNj
IL t
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt
Total Amt. Du
C
Receipt #
APPLICATION APPROVAL
niis application is riot a pennit until signed by the
Building 01116,11 or tus)her Deputy. and Fees ate paid. and
leceij)t 1� ictnowledged Ili space provided
Fj;j(3iAI.5, SIGIJAI URF DAIE
)_.�_L
IlFl FASFD
A17ENTION r.'A I I
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED, UBC1091IBC110/IRC110.
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
_11AL'
DATE
ORIGINAL Fiff YELLOW - INSPECTOR
PINK OWNEF! COLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ...........
Retaining W all ...........
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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