20040719.pdfDATE RECEIVED f
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAM OF BUSINESS
LCC MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
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ZIP TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I
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PROPERTY TAX ACCOUNT PARCEL
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Lj NEW
L�,d RESIDENTIAL
UMBING / MECH
� XADDITION
COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CyDS
FENCE
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DEMOLISH
TANK
OTHER
EiGARAGE
CARPORT
RETAINING WALL
FIRE SPRINKLER
ROCKERY
FIRE ALARM
PE OF USE, BUSINESS OR ACTIVITY) XPLAIN- t+V'
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NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE r � I 'A � � 11, , J., "4,-r7 "
PERMIT EXPIRES
USE
PERMIT
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NUMBER
JOB
ADDRESS
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SUITE/APT#
PLAT NAMEISUBDIVISION NO
OT NO
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TE9CP Appro,01
RW Pofnill floquiled
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EXISTING
— PROPOSED
Street Uso Flormil Rriq'd
Inspection Required
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7,
S,de*.1Ik Haquired
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MET M?LA.�L 1L#INV4V.-L1j1i;iIf(]t dIVIIIIAMUL IFWM JEOUIRED
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OWNFRICON TRAC I O—HRESPONSIBLE nrtzxMLj1J!AI11X6E 6
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-GAS PIPE TEST MUST BE
OBSERVE'll BY Clrf INSPEU)Uli
ENGINEERING REVI E 0 f DATE
AMDAVITS SHAL 0
FIRE REVIEWED BY DATE W
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VARIANCE OR CLI
SHORELINE OR ADB#
I INSF�ECT,1ON'j,.
BOND
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quired
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SIGN AREA
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COMPLET qEMQT
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EXP - .. �1%
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LOT C�O�hA&V!.��._UMLUPM-CZ-.TBAeKS-(Fr.r�MdPOSED
SETBACKS (Fr.)
ALLOWED �'TR'OMC§ED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
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LOT AREA
PLANNING REVIEWED BY DATE
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REO'D I PROVIDED
Fr) I REMARKS
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PLAR CHECK NO!M6 L VES"ISC-D DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTEeTHIS PETfMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:1
SEPARATE PERMISSION.
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W PERMIT APPLICATION: IBODAYS
IL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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_j IN INTERES�r, AGREES TO INDEMNIFY, DEFEND AND 1101D HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIAL S, EMPI OYEES. AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHAT EVER NATURE, ARISING DIRECIIY OR INDIRECHY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHAAI NOT 13E
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REOUIREMEN1 OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION"
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I HEREBY ACKNOWLEDGE THAT I HAVE READ 1iiIS APPLICATION, IIIATTHE INFORMATION
GIVEN IS CORRECT, AND TiIAT I AM THE OWNER, OR TIRE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAI ING CONSTRUC
TION� AND IN DOING THE WORK AUTIIORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIIINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 10 27,
I I DAT� SIGNED
,1 7 1 � .1 10 __)
CHECKED BY j=ON CVME�-? OCCUPAN
GROUP
SPECIAL INSPEC14ON AREA OCCUPANt
REQUIRED LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 0
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VALUATION
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt ft
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
I his application is not a perinit until signed by tire
Building 01ficial or tiisjticr Deputyi and Fees are paid, and
FOR INSPECTION
receipt iti acknowludged in space provided
(425)
OFFICIAIS SPNAIPHF DITE'
j771-022U HEI. EASED BY VATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCC BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILL YELLC&V INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OViNER GOLD - ASSESSOR
0903 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 .................... I-V 7- A2
Gas Piping ................. /22 7
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 ..................
7/1 W000,
Tile illifials MI are Milt011 "Ict
Thollipsoil, a jelliporary colit',
inspector for the C'ty-
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