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CITY OF EDMONDS 2
CONSTRUCTION PERMIT APPLICATION
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PROP9RtY TAX ACCOUNT PARCEL NO. IZ-1s- oz:TQ *5. czczl`?�, ('11"
NEW RESIDENTIAL PLUMBING / MECH
, ADDITION COMMERCIAL COMPLIANCE OR
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REMODEL MULTIFAMILY SIGN
REPAIR G ADIN FENCE
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DEMOLISH TANK
Ei GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
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STORIES UNITS to NUMBER
DESCRIBE WORK TO BE DONE
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VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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FROM T ISSUANCE OF THIP PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED 0 MODIF�4 WAIVE Ofj REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIM ANY WAY THE CMS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY N L E THAT VE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS C RR T: D TH THE OWNER, OR THE DULY AUTHORIZED AGLNT OF
THE OW I RE CQ ITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION: AN 11 D G E W4R HOR17FD THFREBY, NO PERSON WILL BE EMPLOYED
IN VIO TIC LABCIR E OF THE STATE OF WASHINGTON RELATING TO
WORKM N'S C M ATIKVN NCE AND RCW 18.27.
DATE SIGNED
W I I PERMIT EXPIRES -,
ISE PERMIT
ONE _If�
NUMBER
OB SUITEIAPT#
DDRESS
PLAT NAME/SUBDIVISICIN NO. LOT NO, LID NO.
LID FEE $
TESCP Approved C3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW d
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EXISTING PROP SED Inspection Required
Sidewalk Required 13
REQUIRED DEDICATION Fr Underground
Wiring required
METER SIZE NO. OF FIXTURES PAV REQUIRED
LINE SIZE
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YES 1:1 NO 13 FE
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REMARKS z
DWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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:NGINEERING REVIEWED BY
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FIRE REVIEWED BY DA11E U11
VARIANCE OR CU SHORELINE OR ADBH INSPECTION BOND
REO'D POSTED
1 71-CZ>3 - 4/4 10YES GKo is
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
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XPA-104031 IVA IlOt
I LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
NLLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOTAREA I PLANNING REVIEWED BY DATE :5
REO'D I PROVIDED IL
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REMARKS
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'HECKED BY
TYPE OF CONSTRLI;TION Coo
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED XYES LOAD
IEMARKS
3ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
VALUATION
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J070
Description FEE Description FEE
Plan Check State Surcharge
1 717� ___A�g, 5 6
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Building Permit City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection A1114 4fAl pbe��
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Fire Review Plan Chk. Deposit,
Fire Inspection Receipt # ::)7
Landscapeinsp. Total Amt. Due
Recording Fee Receipt III
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, ancl
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIAJ.S SIGNA DATE
(425)
771-0220 nunAsED __ BY —/DATE
ATTENIVN )ll EXT 1333 If,? /Z; _7 Ai0i
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .......................... z
Pier/Porch ................. 0
M
Retaining Wall ...........
Slab Insulation .......... 71
PLUMBING: M
C
Underground .............. M 0
—40
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RoughrIn ................... —1
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Commercial Final ...... M Z
HEATING: C z
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Gas Test . ..................
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Gas Pipin g .................. o -n
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Equipment.
M M
Commercial Final .......
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EXTERIOR SHEATHING M
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NAILING . .......................... C/)
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FRAMING .........................
FIRST FLOOR FRAMING...
INSULATION ................... >
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Floor Insulation ......... -q
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Wall Insulation .........
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Ceiling Insulation .......
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SHEETROCK NAILING ... M
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..... ............
Side Sewer It
17V Amout Paid $ /Z� Receipt
Date USUed
Water Meter Si=
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Amountftld
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DatePurchas
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Amount ii4 ;P /
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