20040691.pdfDATE RECEIVED PERMIT EXPIZ
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CITY OF EDMONDS NUM13ER 12
JOB SUITEIAPT#
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CONSTRUCTION PERMIT APPLICATION, ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO,
UM MAILING ADDRESS LID FEE S
TLSCP Approved E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
T� Street Use Permit Roq'd
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CITY ZIP TELEPHONE EXISTING - PROPOSED I c nspection Required 0
sidewalk Required [3
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NAME METER SlZt LINE 7SIZE NO. OF FIXTURES PRV REQUIRED
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NAME CBL H DUMP AT APPROVED DUMP SITE ONLY
I_ e �— (or 157 ENGINEEIIINS&EVM DATE
ADDRESS OLITION INSPECTION
0 0 CHECKLIST ON BACK OF JOB CARD
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VARIANCE OR Cu SHORELI, E OR ADB# INSPECTION BOND
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q PRO,PERTY TEAN—ACCOUNT PARCEL No. -),7 COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
1:1 NEW Ua"'RESIDENTIAL 1:1 PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
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PARKING LOT AREA PLANNING REVIE ED BY DATE
REMODEL MULTIFAMILY 1:1 SIGN REO'D I PROVIDED
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GRADING FENCE
REPAIR Cyns 1:1 ( x Fr) REMARKS
D--.�EMOLISH TANK 0 OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D 5
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VALUATION
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Description FEE Description 7EE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee J;
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
M
ul PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE 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
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt it
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
MI Recording Fee Receipt 0 ILI j
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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 I his application is not a permit until Signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18-27.
0 r C)"' SIGNATURV/
SIGNATURE NJEP AGEN-0 DATE SAED (425)
771-0220 ;RLEASED BY DAfE
_19111111111 R
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW- INSPECTOR
PANCY HAS BEEN GRANTED. UBCjog/IBC1I0/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:
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
OCCUPANCY ..................
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