20040679.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWN&Q,NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
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CITY ZIP ITELEPHONE
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NAME CBL#
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER E:
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PROPERTY TAX ACCOUNT PARCEL NO.
1-1 -2)L-lb _0C)0_ InS-C
ONEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
E] DEMOLISH TANK
EGARAGE RETAINING WALL
l CARPORT ROCKERY
(TYPE OF USE, BUSINESS ACTIVITY) EXPLAIN-
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PqPLUMBING
/ MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
FT
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES il UNIT'S P<01 I NUMBER
DESCRIBE WORK TO BE DONE
0
c-4,\s cc,
GLAZING %
LOT SLOPE %
PLAN CHECK No* tj VESTED DATE
*0
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: 180 DAYS
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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS 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.4
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 AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATg%4N6QRANCE AND RCW 18,27.
N-0 DATE SIGNED
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS au A
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SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LOT NO,
LID NO.
LID FEE $
I ESCP Approved
0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
MY Permit Required
Street Use Pound Roq'd
EXISTING — PROPOSED
I
inspection Required
Sidewall, Requited
REQUIRED DEDICATION— FT
Underground
[3
wiring required
METER SIZE
LINE SIZE
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FI ru�RES
PAV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
0
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VARIANCE OR CU SHORELINE Of(�ADBI I INSPECTION BOND
0Y REOID POSTED
I 0;� - I ES NNO Is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA Prl�INJG -E
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RE OVIDED RE ED Y ell 610 a.
REMARKS, iWA
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CHECKED BY JTY��CON TRUCTION uliluu!"INNI
GRON 7D
SPECIAL, INSPECTION JAREk OCCUPANT
REQUIRED [] YES LOAD
REMARKS 15
PROGRESS INSPECTIONS PER UBC 108 / IBC1 09 1 IFIC1 09 FINAL INSPECTION RECI'D I zF3
A
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
'17
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscape Insp. Total Amt. Due
I
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building 011icial or his/tier Deputy; and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
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(425)
771-0220 RELE 0S&D BY
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EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPI
ORIGINAL - FILE YELLOW - INSPECTE
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 ....................
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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