20040686.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CIT ZIP
ITELEPHONE
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NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME
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ADDRESS
CITY. LEPHONE
ZIP TE
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STATE LICENSE NUMBER EXPIRATION DATE _T —CHE—CKEDgy
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PROPERTY TAX
ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
El ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
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GARAGE
CARPORT
RETAINING WALL
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ROCKERY
E:
(TYPE OF USE, BUSINESS OR ACTIVITYLV M-P.T AIN 77—
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
X
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
13 PLUMBING / MECH
oCOMPLIANCE OR
CHANGE OF USE
SIGN
E FENCE
( � X FT)
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FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
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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: 1180DAYS
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 DIRECrILY 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 CHYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
USE
ZONE
JOB
ADDRESS
I PERMIT EXPIRES
PERMIT
NUMBER
PLAT NAME/SUBDIVISION NO. __F_LoTNO.
4 1-k
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
PROPOSED
REQUIRED DEDICATION� FT
METER S17F LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
TESCP Approved 13
RW Pormil Requited E3
Street Use Permit Roq'd
Inspection Required
Sidewalk Required
Underground
Wiring required 13
PRV REQUIRED
YES E3 NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
I W15-1 RILTIC!� ezo :1
d_L_aU_AL_. -
ENGINEERING REVIEWED BY
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FIRE REVIEWED BY
DATE
911-11'
DATE
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VARIANCE OR CU SHORELINE ORADB# I INSPECTION BOND
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REq'D., POSTED
OYES )qNO S
=SEPA REVIEW SIGN AREA HEIGHT
COMPLETE :EXkEPT ALLOWED PROPOSED ALLOWED I PROPOSED
EXP ;�S It '6
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWE , D PROPOSED FRONT SIDE REAR FRONT YR SIDE R
OX 0 1( z
71" 76'N
a/ yo, �S 7� 15 A
PARKING LOT AREA RZNG REV DATE
REJ� PATED _PEVIqWEP BY
REMARKS
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CHECKED BY TYPE D CTION COM OCCUPANT
OCCUP
GROUP
OUP
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PECIAL INSPECTION AREA OCCUPANT
L I TO CU
QUI E3 Lo
FFREQUIRED [] YES LOAD
REMARKS a
PROGRESS INSPECTIONS PER UBC 1081IBC109/IRCID9 FINALINSPEC-nON REQ'D
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VALUATION
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FEE
Description
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State Surcharge
City Surcharge
Base Fee
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Plan Chk. Deposit
Receipt # :2
TTot 1 .1, -.7
otal Amt. Due
I HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION; THAT THE INFORMATION J—/,-(-/ A4 1)
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICAT—ION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL 13E EMPLOYED CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON Building Official or his/tier Deputy: and Fees are paid, and
WORKMEN'S,��ATION INSURANCE AND RCW 18 27. RELATING TO FOR INSPECTION receipt is acknowledged in space Provided.
SIGNATI-InT WNER 0 AGFNI) DAT . E SIGNED (425) OFFICIALS SIGNATURE D TE
771-0220
RELEASED By
FEE
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
All t: 110 ATE
E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. ORIGINAL/ FILE YELLOW - IN PECT�
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK - OW GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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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