20040578.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
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NAME
DDRESS
CITY ZIP I TELEPHONE
NAME CBIL I"
ADDRESS
CITY ZIP TELEPHONE 775-67
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX
'2-109
ACCOUNT PARCEL NO.
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0 NEW
XRESIDENTIAL
>V ELUMBfN ;I MECH
ADDITION
F-1 COMMERCIAL
COMPLIANCE OR
1:1 CHANGE OF USE
t<REMODEL
MULTIFAMILY
M SIGN
REPAIR
GRADING CYDS M FENCE
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DEMOLISH TANK El OTHER
GARAGE
E:i RETAINING WALL FIRE SPRINKLER
CARPORT
ROCKERY FIRE ALARM
(TYPE OF USEBVSINESS,
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NUMBER
NUMBER OF
CRITICAL
R'T'C L
OF
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DWELLING
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FAREAS
STORIES
UNITS
NUMBER
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DESCRIBE WORK TO BE DONE
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SOURCE GWING % I LOT SLOPE%
PLAN CHECK NO: N I V I 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: ISO DAYS
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
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER
JOB
ADDRESS 61 1 -7 45 Vii/
PLAT NAME/SUB SION NO. LOT 0.
N
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
I
IESC mad
RW P::t laquired
13
Street Use permit Hoq'd
[3
inspection Required
13
Sidewalk Required
E3
Underground
Wiring required
13
PRV REQUIRED
YES [3 NO 13
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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FIRE REVIEWED BY DATE Lu
VARIANCE OR CU SHORELINE OR ADB11 I INSPECTION BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRE D SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR 0
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED I I IL
REMARKS
CHECKED BY
SPECIAL INSPECTION JAREA
REQUIRED [] YES
OCCUPANT
GROUP
OCCUPANT
LOAD
,3
REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109 / IRC109 FINAL INSPECTION REQ'D
VALUATION
$ D`7 j
Description
Plan Check
Building Permit
FEE Description
0 0 State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his1her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIONJN$URANCE AND RCW 18.27.
Of 7F!q DATE
, !�;IGNATPFE
SIGNATURE (DINNER CQR�A�GO DATE SIGNED (425)
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ATTENTION EXT 1333
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL U—Li
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED, UBC109/IBC110/IRC110.
FEE
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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711.p
ORIGINAL YELLOW- INSPECTOR
PINK -OWNER GOLD -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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. EL
200quo 0579
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