20040716.pdfDATE RECEIVED
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[PERMIT EXPIRES
CITY OF EDMONDS
IMP PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
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OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE S
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MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
TESCP Approved 6-
RW Permit Required 0
Street Use Permit Roq'd [3
inspection Requited Q
Sidewalk Required E3
Underground
Wiring required
CITY ZIP
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TELEPHONE
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NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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CITY ZIP _TLEPHONE
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through unfleated spaces. UWC 803.2
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REQUIRED SETBACKS (Fr.)
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PROPOSED SETBACKS (FT)
FRONT UR SIDE REAR
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PARKING
REQ'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
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REPAIR GRADING Ei FENCE
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REMARKS
DEMOLISH TANK OTHER
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NUMBER OF
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NUMBER
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OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE ke j_-Le-
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REMARKS
PROGRESS INSPEC71ONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
0
Base Fee
PLAN CHECK NO:
VESTED DATE
Mechanical
20
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
Fire Review
Plan Chk. Deposit
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
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
Fire Inspection
Receipt #
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Total Amt. Due
1
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0
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,,
Recording Fee
Receipt #
I 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
7PPLICATION APPROVAI
This application is not a permit until signed by the
CALL Building Olficial or his/her Deputy: and Foes are paid, and
FOR INSPECTION receipt is acknowledged in space provided,
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
I OlIC41 n.SIGNATURE DATE
(425)
771-0220 zrBY DATE1 _T
SIG7NATUR (OW!7n4G;E V1111
DATE SIGNED
ATTENtION
EXT 1333
IT IS UNLAWFULTO USE OR OCCU PYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
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:
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 .................. VV6 C-1 - L
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