20040663.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
IER NAMENAME OF BUSINESS
USE
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JOB
ADDRESS
PLAT NAME/SLRBDIVISION NO.
PERMIT EXPIRES R�(
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PERMIT
NUMBER
I SUITE/APT#
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LOT NO,
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TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
�2, 1�645 Street Use Pornut Req'd 0
CITY EXISTING - PROPOSED Inspection Required 13
ZIP TELEPHONE Sidewalk Required E3
REQUIRED DEDICATION� FT underground
:Lz Meng required 13
LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13 z
NAME METER SIZE
W
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ADDRESS REMARKS z
OWNER/CONTRACrOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
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CITY ZIP TELEPHONE
NAME^ BL#
B ENGINEERING REVIEWED BY DATE
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ADDRESS
FIRE REVIEWED BY DATE W
CITY
VARIANCE OR CU SHORE LI NE OR AD1111 INSPECTION 7OND
STATE LICENSE NUMBER Y REO'D POSTED
CIM61V& __-) ��l lu I OYES ONO $
4�3 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. co EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
60 "YT11-1 coz_� C/ SQ,_-�2 - EXP I
I" LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
014�EW RESIDENTIAL 0k,11LUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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COMPLIANCE OR -2
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL ;-INI �ULT I FA M I LY SIGN REQ'E
GRADING FENC
REPAIR CYOS D ( X Fr) REMARKS
[—] OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS RA _Y)
.0 IT fT PLAIN'
71ON CODE OCCUPANT
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PWII TYH 10171, M
i! NUMBER REQUIRED [
NUMBER NUMBER OF CRITICAL O1,CUPANT
OF ,7 DWELLING AREAS SPECIAL INSPECTION JAREA LCAD
UNITS 3 L
STORIES 1 3 kA_
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108 IBC109/ IRC109 FINAL INSPECTION REO'D
3 a)
2
flb 131b --,) FIE VALUATION
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. / Description FEE Description FEE
P Ian Check State Surcharge
HEAT SOURCE
F GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
r_2
Base Fee
PLAN CHECK NO:
VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVER WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
Engr. Review
r PERMIT APPLICATION: IBODAYS
u
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR PADRE INFORMATION
'APPLICANT, 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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
SHALL NOT BE
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT
Landscapelnsp.
Total Amt. Due
0 EQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY R
A
Cl NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW'
x
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE T1 IAT I HAVE READ THIS APPLICATION; THAT T) IE INFORMATION
APPLICATION
APPRIL)VAL
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
This application is not a permit until signed by the
TION; AND IN DOING THE WORK &THORIZED THEREBY. NO PERSON WILL BE EMPLOYED
OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
IN VIOLATIO" IE LABOIP/i�bDE OF THE STATE
-
rC^WORK�fp'S PE ATIOYN/URANCE AND RCW 18.27.
�OFII/C,11&SIGNATURE
Q0 bRE 106NER A e
DATE SIGNED
(425)
7
7NL
771-0220
'DATE1
EASED BY
T
EXT 1333
UN FULTO SE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
I rSPE
E IWONHASBEEN AIDE AND APPROVAL ORA CERTIFICATE OF OCCU
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ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
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..........................
Pier/Porch ........ I ........
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............. CM3
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 *3
OCCUPANCY ..................
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