20040675.pdfDATE RECEIVED ( /
PERMITEXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER VLI._�(XO 4_�>
CONSTRUCTION PERMIT APPLICATION JOB SUITE/API#
ADDRESS /0/11//
OWNER NAMEINAME OF BUSINESS 4"_'
Pt;T NAME/SUBDIVISION NO LOT NO.
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
I.- AUDRESS
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CITY ZIP TELEPHONE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— F1
METER SIZE LINE SIZE NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
13
RW Permit Required
13
Street Use Permit Roq'd
[3
Inspection Required
13
Sidewalk Required
13
Underground
Winng required
0
PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONrROL/DRAINAGE
NAME CBL ENGINEERING REVIEWED BY DATE
ADDRESS
C.— LEPHONE
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STAf 0 LICENSE NUMBER PIRATIOIN DATE CHECKED BY
ROPERTY. TAX ACCOUNT PARCE NO.
NEW
E] RESIDENTIAL PLUMBINGIMECH
ADDITION
COMPLIANCE OR
P�COMMERCIAL
CHANGE OF USE
E] REMODEL
11 MULTIFAMILY P�S �IG N
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OTHER
GARAGE
RETAINING WALL
1:1
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINE sr,
R ACTIVITY) EXPLAIN:
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NUMBER
NUMBER OF
CRITICAL
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UNITS
NUMBER
DESCRIBE WORK TO BE DONE
(-)T G,/�j
HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO: n 1" 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: 180DAYS
PERMIT LIMIT. 1 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
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTtY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS 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 THAT I I 1AVE READ TI IIS APPLICATION; THAT TI IE INFORMA1 ION
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 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSA/T)ON IN�VRANCE AND RCW 18.27.
FIRE REVIEWED BY DATE
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ALLOWED �RCPO
HEIGHT
ALLOWED PROPOSED
EXP >�'
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LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
V\/1 1'T-'�- )d/--,
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
I
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
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Receipt # 7
1 - Ljq 57
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
IFICIALS SIGNATVJIE DATE
SIGN DAI E SIGN
7=�A SIGNED
771.0220L —LS FAS
ATTENi'1014 E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL -FILE YELLOW- INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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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 ....................
GasPiping .................
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 434
OCCUPANCY ..................
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