20040740.pdf4
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DATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZI TELEPHO14E
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NAME
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CITY ZIP TELEPHONE
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NAME CBL Or
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
LOT NO. LID NO.
LID FEE $
TESCP APPrOv0d
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Rw Permit Required
E3
Street Use Permit Rmt'd
[3
EXISTING - PROPOSED
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Inspection Required
[3
Sidewalk Required
E3
REQUIRED DEDICATION- FT
Undotgfound
IN red
P2R2222-77
[3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV EQUIRED
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I YES M NO 1:1
REMARKS
OWN ERICON TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
4::�p ENGINEERINGnEVIEWED BY DATE
ADDRESS I
6 1149& 1 CID= pirvipwrn BY DATE
CITY ZIP TELEPHONE I
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STATE LICENSE NUMBER EXPIRATION DATE CHECKE4 BY
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESI
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
FIETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
IN,,IPLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
W NUMBER NUMBER OF CRITIGALjW,0V)t
0 OF DWELLING AREAS
M NUMBER
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
LOT SLOPE %
PUN CHECK NO: VESTED DATE
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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 APPUCATION: 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 NXI URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITYTO ENFORCE ANY ORDINANCE PROVISION.*
VARIANCE OR CU SHORELINE OR ADB# INSPECTION I BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED I ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FF.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
REMARKS
CHECKED BY [IFIE OF CONSTRIXTION CODE OCCUPANT/)
GROUP Ko
SPECIAL INSPECTION JAREA ij OCCUPANT
REQUIRED [3 YES I LOAD
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REMARKS ECI'D A
PROGRESS INSPECTIONS PER UBC 108 / IBC109 / IRC109 FINAL INSPECTION R� _j
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 Arnt. Due
Recording Fee
Receipt #
'74
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0 . FFICIALS SIGNATURE /F D7AE
DATE SIPNED (425
si TURE W 5RXEP
tp" I I \/) .. X�-1
771-0220
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL 177za
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109116CIIO/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
-FILE
ORIGINAL YELLOW I SPECTOR
PINK - OVVNER - GOLD � ASSESSOR
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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 e)
OCCUPANCY .................. MT
The I'litials N4T arc Milton
Tho"VsOli, a tel,11jorary colitract
illsl3cctor for tile city.
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