20040627.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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NAME
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USE PERMIT
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ZIP TELEPHONE EXISTING PROPOSED
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STATE LICENSE NUMBER EXPIRATION DATE
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[]2/NEW RESIDENTIAL
PLUMBING MECH
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COMPLIANCE OR
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REMODEL MULTIFAMILY
SIGN
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GRADING
REPAIR CYDS
FENCE
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E] DEMOLISH TANK
OTHER
oGARAGE Ei FIETAININGWALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE U I NESS, Ofk�Clrlyffy) EXPLAIN:
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NUMBER
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NUMBER OF
DWELLING
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STORIES
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NUMBER
DEfCRIBE WORK TO BE DONE -97 11
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PLAN
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VESTED DATE
LID NO,
LID FEE $
IESCP Approved
RW Ponnil Required
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Street Use Permit Roq'd
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Inspection Required
E3
Sidewalk Required
E3
Underground
Wiring required
PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADEIN
INSPECTION
BOND
REQ'D
POSTED
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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EXP
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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PR TION REQ D 63
PROGRESS INSPECTIONS PER UBC JOB/IBC109/IRC109 FINALINSPEC
03
4�t I
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
IM104-
11?�' State Surcharge
City Surcharge
Base Fee
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt
Landscapelnsp. Total Amt. Due
Receipt #
Recording Fee
APPLICATION APPROVAL
I his application is not a permit until signed by the
CALL Building official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
QFFICIpAi�SIG,NAYURE DATE
(425)
__)`
771-0220 'RE[FASED DAn
L
ATTENTION
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- RIGIN FILE YELLOW - IN/PECT(IR
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PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCIIO. PINK - NER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
V �*��ff'72 - I -
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: 100 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERK41T FOR MORE INFORMATION
'APPLICAN1, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOi D HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIREC fiY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF [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."
I HEREBY ACKNOWLEDGE TIIAT I HAVE READTHIS 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 CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED TIIEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION �4'GYRANCE AND RCW to
SIGNED
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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 ....................
fNA
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
7
OCCUPANCY ..................
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