20040718.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NIJIMBER,4A"�-- 71j5'
JOB ITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRE
OWNER NAME/NAME OF BUSINESS ss
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cc MAILING ADDRESS LID FEE $
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z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Required E3
*0/ 'od z..j5,& .410V Z14,11 7 S110111 USO Permit Roq'd 13
0 inspection Required 13
CITY ZIP :J�4ELEPH ONE HIS I ING — PROPOSED Sidewalk Floquired E3
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7 z C-) REQUIRED DEDICATION— Fr Waing required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
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OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE F3
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
d /-'I; _7416 A-1 C 7 eAkie - I SIGN AREA 10YES EINOis HEIGHT
SEPA REVIEW
PROPERTY TAX ACCOUNT PARCgL IND. - COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SET13ACKS (Fr.) PROPOSED SETBACKS (Fr.)
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NUMBER OF C RITICAL OCCUPANT
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PROGRESS INSPECTIONS PER UBC 108 IBC1 09 IFIC1 09 FINAL INSPECTION REQ'D
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
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PLAN diE�7,' V111E1 DATE Base Fee
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
2 DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:I SEPARATE PERMISSION.
10- — Engr. Review
M PERMIT APPLICATION: 180DAYS
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CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
hk. Deposit
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan C
IN INTEREST AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, 11kASHINGTON, ITS OFFICIALS. EMPIOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE. ARISING DIRECTLY OR INDIRECTLY
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X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE Or THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due q
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION * I
x Receipt #
"I - Recording Fee
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Building ollicial or his/tier Deputy: and Fees are paid, and
TION, AND IN DOING THE WORK AU-niORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION iocLipt is acknowledged in SflacVptoviclod�
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
OFF 141:8 [)AT E
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SIGNATURE (OWNER OR INT) DATE SIGNED (425)
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ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL MAOZ� LI
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL FILE YELL - INSPEOI(OR
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 ..................
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