20040608.pdfI
DATE RECEIVED
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PERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
ZONE MBER
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JOB SIJITE/APT#
ADDRESS
OWNER NAM_E/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
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(2
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICAJION� F-I
IESCP Approved U
RW Permit Required 13
Street Use Permit Floq'd [3
Inspection Required 0
SidowrIk Hequired E3
Underground
wiring required E3
CITY ZIP
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TELEPHONE
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NAME
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES13 NO 13
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ADDRESS
REMARKS
OWNER/CONTRAC1OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP
TELEPHONE
NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE rREVIEWED BY DATE
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CITY ZIP
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TELEPHONE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REQ'D
OYES ONO
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POSTED
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STATE'LICENSE NUMBER EXPI IN
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CH CKED BY
SEPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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7 5�40
NEW RESIDENTIAL PLUMBING / MECH
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ADDITION COMMERCIAL COMPLIANCE OR
1:1 CHANGE OF USE
REMODEL MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT UR SIDE REAR
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PARKING
REO'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
5
GRADING FENCE
REPAIR CYDS ( — X —Fr)
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REMARKS
DEMOLISH 1:1 TANK E] OTHER
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E]GARAGE E:i RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, Bus R ACTIVIM EXPLAIN:
CHECKED BY
TYPE,,9F CONSTRUCTION
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OCCUPANT
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NUMBER
OF ZA
STORIEV ;��04 1
NUMBER OF
DWELLING
UNITS 1
CRITICAL
AREAS
NUMBER V20��
SPECIAL INSPECTION—
REQUIRED [] YES
1ki-EA
OCCUPANT
LOAD
—
DESCRIBE WORK TQ_BE DONE
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
6
ECK NO:
VESTED DATE
Plumbing
Base Fee
Mechanical
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a.
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.
Grading
Engr. Review
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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= 01
'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 DIREC RY OR INDIRECI LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
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. -
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
—TR7eceipt
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THE
TION;
I.N
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
OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC-
AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL-,,,,, Building Olficial or his/her Deputy: and Fees are paid, and
FOR INSPECTION. receipt is acknowledged in space provided.
OF, c SIG3VNU DATE
(425)
771-0220 RE'ILEVE61134
SIGN
UR R
DATE SIGNED
ATTEN,P6N
E)ff 1333
IT
IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UN IL
A
CATE
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIF
OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
ORIGINAL - FILE - YELLOW - INSPECTOR
PINK - OWNER - 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..........................
z
0
Pier/Porch .................
—4
0
Retaining Wall ...........
M
Slab Insulation ..........
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Fn
PLUMBING:
0
M
C
Underground .............
M
0
Rough -In ...................
C:
—4
Commercial Final ......
X M
M Z
HEATING:
C
r— —4
Gas Test ....................
x
Gas Piping .................
0 -n
-n
Equipment .................
M M
Commercial Final .......
0 5
0
EXTERIOR SHEATHING
0 M
NAILING ..........................
C Cn
90)
Q 0
FRAMING ........................
Z r—
FIRST FLOOR FRAMING...
;U
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
0)
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Ceiling Insulation .......
0
SHEETROCK NAILING ...
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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