20040618 (2).pdfOATE RUCEIV[D I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY
NAME
ADDRESS
CITY
NAME
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ADDRESS
CITY
611z
STATE LICENSE NUMBER
ZIP TELEPHONE
ZIP ITELEPHONE
ZIP TELEPHONE
EXPIRATION
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
0
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NEW RESIDENTIAL PLUMBING / MECH
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL E] MULTIFAMILY SIGN
GRADING FENCE
REPAIR CYDS ( — X—FT
DEMOLISH TANK
OTHER
GARAGE RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
(TYPE OF USE, BUSOF SS OR ACTIVITY)
NUMB
NUMBER OF
CRITICAL
UP
M
OF
DWELLING
AREAS
5
0
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NITS
NUMBE
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING 4 LOT SLOPE %
PLAN CHECK 40�., VESTED DATETj/
USF
"Orif
JOB
A00FIESS
FIAT NAMEiSUBDIVISION NO
PERMITEXPIRES //t
PERMIT
NUMBER
S AP
/I LOT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Appfoyod
RW Permit litiquifod
13
13
street use P011,11.1 Hoq.d
13
EXISTING — PROPOSED
inspection Requaed
Q
sidewalk Required
E3
REQUIRED DEDICAIION_ Fr
Undeigiound
Wiring required
E3
METER SIZE
LINE SIZE
NO- OF FIXTURES
PRV REQUIRED
YES 0 NO 0
CC.
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CIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMITO'COVE6 WORK TO
t= 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
W
CL 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGEN rS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcrLYoR INDIRECIIY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
'"ON; AN IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VI OL ION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORK�j 'S COMPENSATION INSURANCE AND RCW 18,27.
DATE SIGNED
7 SIGN RE AER �R AGENT)
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED 13Y DATE
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VARIANCE OR CU
HOSELINE OR ADB#
INSPECTION
BOND
REQ'D
POSTED
Is
OYES
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SERA REVIEW
COMPLETE EKMPT
IGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
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EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
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PARKING
LOT AREA
PrNING REVIEWIED�BY
DATE
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REMARKS
CHECKED BY I TYPE OF
OCCUR
GROUP
SPECIAL INSPECTION JAREA MoUILIVAN I
REQUIRED [—
_] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108 if IBCI 09 / IRC1 09 FINAL INSPECTION REQ'D
VALUATION
$ - W:5 0, .—
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Description
FEE
Description
FEE
Plan Check
State Surcharge
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Building Permit
City Surcharge
Plumbing
Base ee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
3�?-
Recording Fee Receipt # I
APPLICATION APPROVAL
This applicaiion is not a permit until signed by the
CALL Building oificial or his/her Deputy: and Fees are paid. and
FOR INSPECTION— receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
(425)
. 6�, 1-1.
771-0220 RE - ED BY I DAIE
. �, I) A 11
A17ENTION
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL 41111�n
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSP TOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCi10. PINK - OWNER GOLD - ASSE SOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECEIVED
JUL 9, 2004
DEVELOPMENT SERVICES
MEMORANDUM
7/28/04 z
Date:
To: Debbie Karber, Accounting Assistant
R1
Marie Harrison
From:
Subject: REFUND rn
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k in the amount of $32.50. Please mail the check to James z
Debbie, please prepare a refund chec
der the estimate.
020. The bid came in un C
Harkins at 1006 Sprague Street, Edmonds, WA 98 z
eipt #24356 for >
duct from the building permit fund. I have enclosed a copy of our rec
Please de
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your records. Thank you.
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Sincerely, C cn
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Director's Signature
Development Services Division X
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City of Edmonds cQ Community Services
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
cas
NAILING ..........................
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FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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