20040599 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
NAME
12" �-57
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JOB
ADDRESS X0
PU%T NAME/SUBDIVISION NO.
PERMIT EXPIRES 1
PERMIT
NUMBER
7 , _46 iD�
LOT NO.
/cv PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
PHONE EXISTING — PROPOSED
ZIP REQUIRED DEDICATION— FT
I METER SIZE I LINE SIZE I NO. OF FIXTURES
ZIP
TELEPHONE
__�DDRESS
1512z
CITY ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE WHECKE Y
PROPERTY TAX ACCOUNT PARCEL NO. -
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
ned
ZPLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x Fr)
OTHER
FIRE SPRINKLER
FIRE ALARM
SUITE/APT#
0/46
LID NO.
LID FEE S
IESCP Approved
13
RW Permit Required
E3
Street Use Paunit Roq'd
13
Inspection Required
Q
Sidewalk Required
13
Underground
Wiring required
PRV REQUIRED
YES 11 NO 13
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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F3
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VARIANCE OR CU
SHORELINE OR ADBN
INSPECTION
BOND
REO'D
POSTED
OYES 0 No
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
,
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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2
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
CHECKED BY ITYPE OF CONSTRVCTION C_QQE ULUurA
N,, GROUP
CRITICAL IV D'
AREAS SPECIAL INSPECTION AREA OCCUPANT
NUMBER REQUIRED [] YES LOAD
REMARKS z
1PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINAL INSPECTION REQ'D F3
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee go
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2
Engr. Review
Cr
1.11 PERMIT APPLICATION: 180DAYS
-
IL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANL ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI. ESS THE CI FY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALI. CLAIMS FOR DAMAGES OFWHArEvER NAIURE,AIIISINGOIRECIIYORINDIRFCIIY
x FROM THE ISSUANCE OF THIS PERMH ISSUANCE OF I HIS PERMIT SHALL NOT BE
a
Landscapelnsp.
Total Amt. Due �5
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENI OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY 1HE CHYS ABILITY TO FNFORCE ANY ORDINANCE PROVISION
x
Receipt # -zij
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Recording Fee
1cl
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
---
APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAI I AM THE OWNER, OR THE DUIY AUTHORIZED AGENT OF
THE OWNER. I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
I tits application is not it pelnut until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PFRSON WILL BE EMPLOYED
Building Official of lus/t)Lr Deputy and Fees are paid, and
IN V6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
jij�cajpj is acknowlt)dged fit space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 10 27
F LA SIGNATUII( A TE
SIGNATURE (OWNER DATE SIGNED
(425)
Jc-
tGENT
771 -0220
-AS DA
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13Y
11 1 :ASFD HY
11 1
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL E711-F YELLCM -INSPECTOR
PANCY HAS BEEN GRANTED. UBCI09/lBC110/IRCII0. PINK - OWNEH GOLD ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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 .................
>
C_ 2.
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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