20040637.pdfDATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPI RATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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B/NEW RESIDENTIAL n/PLUMBING / MECH
F ADDITION COMMERCIAL COMPLIANCE OR
1:1 CHANGE OF USE
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HEAT SWRCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO; VESTED DATE
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: ISO DAYS
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n. 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 AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT BE
51 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-
TION; AND IN DOING THE WORK AUTI JRIZED THEREBY. NO PERSON WILL BE EMPLOYED
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IN VIOLATIONOF�,TfiE LABOR Co 0 F THE STATE OF WASHINGTON RELATING TO
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W17IRKMEN'S"MPENSATION INSYNCE AND RCW 18.27.
DATE SIGNED
PERMITEXPIRES `4c:j��
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USE PERMIT ��)r 7
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PLAT NAME/SUBDIVISION NO LOT NO LID hO
LID FEE $
TESCP Approved E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Aw Permit Rflquuod E3
Street Use Permit Roq'd E3
EXISTING - PROPOSED Inspection Required 13
Sidewalk Requited E3
REQUIRED DEDICATION- FT Underground
wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO 13
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[ACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
GUIVIVI-tit EXEMPT
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LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADB# I INSPECTION BOND
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PROGRESS INSPECTIONS PER UBC 108/IBC10911RC109 FINALINSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt
APPLICATION APPROVAL
This application is no! a pormit until signed by the
Building oiiiciii or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FFIMAI 9 SIGNAIURE - DATE,
A TION
Tyfm
T 11 LAWFULTO USE OROCCUPYABUILDING OR STRUCTURE UNTILA FINAL
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INS ECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pie0o'rcfi�
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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