20040739.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF 13USINESS
MAILING ADDRESS
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CITY
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NAME
ADDRESS
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NAME
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ADDRESS
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STATE LICENSE NUMBER
TELEPHONE
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TELEPHONE
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CEIL
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PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
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MULTIFAMILY
SIGN
El REPAIR
GRADING FENCE
CYDS X_
13 DEMOLISH
E3
TANK
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m GARAGE
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RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
'3
M OF DWELLING
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
(,L,�j 7;1 L-L 5'e 1, v FIC,
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
CRITICAL
AREAS
NUMBER
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I PERMIT EXPIRES V--f4
USE
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PERMIT
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NUMBER
JOB
ADDRESS
/APT #
PLAT NAMEISUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved [3
Rvy Permit Hertirifed [3
Street Use Permit Rart'd 0
EXISTING
— PROPOSED
inspection Required Q
Sidewalk Required E3
REQUIRED DEDICATION—
FI
Underground
winno required C3
METER SIZE
LINE SIZE
1
OF FIXTURES
7
pRV REQUIRED
YESE3 NO 13
REMARKS
OWNER/CON TRACI OR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE uj
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
10YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I —
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED] FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ-D I PROVIDED
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LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I 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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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
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 AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TIkE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S Cqhff�kl`4ATION INSURANCE AND RCW 18.27.
SIGNATr (� MNAGENT) DATE SIGNED
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CHECKED BY VE OF CONST��CTION CODE OCCUPANT
GROUP I
SPECIAL INSPECTIO� AREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRCID9 FINAL INSPECTION REQ'D
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
LandscapeInsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
=%
(4251
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building ollicial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS JDAT
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ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC 109 / IBC1 10 / IRC1 10.
09/03 PRESS HARD -YOU ARE MAKING 4 CO
ORIGINAL -FILE YELLOW-FNSPECIO
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
0
_q
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
Underground ............. 0 M
iTi 0
Rough -In ................... 0
0
Commercial Final ...... 0
3: M
HEATING: M z
Gas Test .................... C:
Gas Piping .................
Equipment ................. 0 -n
n
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING .......................... 0 r-
0 171
C: co
FRAMING ........................
M 0
FIRST FLOOR FRAMING ... - ---------------- Z
71
INSULATION ................... ;U
--I
3:
Floor Insulation ......... >
z
Wall Insulation ...........
Ceiling Insulation ....... Cn
z
0
SHEETROCK NAILING ... I
0
SPECIAL INSPECTION ... 171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0 731