20040689.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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STATE LICENSE NUMBER
EXPIRATION DATE F 7
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
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ADDITION
COMMERCIAL
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MULTIFAMILY
REPAIR
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DEMOLISH
TANK
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RETAINING WALL
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PLAT NAMEISUBDIVISION NO LOT NO. LID`NO.
LID FEE $
IESCP Approved
11
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
Street Use Permit Req'd
13
EXISTING - PROPOSED
Inspection Required
13
Sidewalk Required
E3
REQUIRED DEDICATION- FT
Underground
Wiring required
E3
METER SIZE
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LINE SIZE
NO OF FIXTURES
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PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
FIRE REVIEWED BY
0
DATE
DATE
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
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LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (F-T.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
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REO'D I PROVIDED
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CRITICAL
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIRED LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109 IRC109 FINAL INSPECTION REQ'D
16
LOT SLOPE %
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.
cc PERMIT APPLICATION: IBODAYS
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PERMIT LIFAIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 11 SO DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W *APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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4c ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
a DEEMED 10 MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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x 01 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. 08 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 COMPENSATION INSURANCE AND RCW IB-27.
DATE IGNED
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VALUATION
Description
FEE
FEE
Plan Check
tDiescription
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
e7'
Landscapeinsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION API 2ROVAL.
This application is not a permit until signed by the
CALL building Official or his/tier Deputy: and Fees are paid. and
FOR INSPECTION receipt is acknowledged in space provided
OFFICIALS SIGNATURE DATE
(425)
771-0220 PIECE SED BYi
I
ATTENTION I jjj ;4
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF CCCU- 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 .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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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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