20040733.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
PH NAME/NAME OF BUSINESS
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NAME
ADDRESS
CITY
ADDRESS
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CITY.
STATE LICENSE NUMBER
NEW
ADDITION
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1:1 REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
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TELEPHONE
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
ACTIVITY) EXPLAIN:
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CBL#
DATE CHECKED BY
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
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NUMBER
NUMBER OF
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OF
DWELLING /\�
AR AS
0
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE . . � 1
WE MIT&
HEAT SOURCE GLAZING LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
i= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUI E
R
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
CL LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
In 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
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III 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
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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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 A THORI ED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOVA�ION OF THE LABO i THE STATE OF WASHINGTON RELATING TO
WORKVE$'S COMPENSATLON l�) YAND RCVY 1&27.
E (OWNER OR AGEq(
DATE SIGNED
17, -11) A
USE
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PLAT NAME/SUBDIVISION NO
LPERMIT EXPIRES
PERMIT
NUMBER
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LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING � PROPOSED
REQUIRED DEDICATION. Fr
MEIER SIZE LINE SIZE NO. OF FIXrURES
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ISUI�EIAPT#
LID NO.
LID FEE $
TESCP Approved [3
RW Permit Required El
Street Use Permit floq*d 13
Inspection Required 13
Sidewalk Required 0
Underground
Wiring required 13
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE 0 RCU
SHORELINE OR ADB11
INSPECTION
BONI)
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POSTED
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N
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SIGN AREA
HEIGHT
COMPLETE EXE T
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
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I 13 5
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
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FRONT L/R SIDE REAR
PARKING
REQ'2._j ROVIDED
LOT AREA
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REMARKS
CHECKED BY TYPE CO s COD OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/IRC109 FINAL INSPECTION REQ'D El
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
7711ALS SIGNATURE DATE
�v/
RE
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- 11
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW
PINK -OWNER GOLD-
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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:
GasTest ....................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION .......... I .........
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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