20040632.pdfDATE RECEIVED.
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE E
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C L �_(:: 11, �_Vol I 1'-n -o+� �j
PROPERTY TAX ACCOUNT PARCEL NO
NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT El ROCKERY
(ME OF USF," BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
PLUMBING
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
FT)
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
PLAT NAMEISUBDIVISION NO
PERMIT EXPIRES
r- r_ r11 [VI I I
NUMBER
LOT NO.
PUBLIC FIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— F1
METER SIZE I LINE SIZE I NO. OF FIXTURES
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EIAPT#
LID NO,
LID FEE $
TESCP Ariptoworl
RW Permit Required
Street Use Permit Rod'd
inspection Required
Sidewalk Required
Underground
Winno required
PRV REQUIRED
YES 0 NO 0
on fitel-burningappliances pasSing
through 1.111heated Spaces- 1AIC 803.2
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE UJI
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VARIANCE OR CU SHORELINE ORADBI I INSPECT101' D
REO'D PBOOSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REGO I PRO%
REMARKS
CHECKED BY JTYPE� C ,4�
N OCCUPANT
011!111 GROUP
CRITICAL
AREAS SPECIAL INSPECTION" AREA OCCUPANT
NUMBER REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D Zi
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VALUATION
U Description FEE Description FF_t�
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surch4lKyel
PLAN CHECK NO: VESTED DATE Plumbing
A.
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERSwonKTO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180DAYS
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IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICAN1, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
cr ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. D]uel(,L.
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt III A 41
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
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. CALL I [its application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTO FOR INSPECTIO
N RELATING TO receipt is acknowl edged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27, F1
11 IVA S SIGNATURE DA E
NATURE (OWNER 0 E4 DATE SIGNED
(425)(
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Tz 771-0226� /A ) EASED BY MATE
ATTENTION EXT 13%J%A
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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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 ..................
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