20040747.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINES; '
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CITY
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NAME
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NAME
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ZIP TELEPHONE
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ZIP
TELEPHONE
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CEIL #
I ei PERMIT EXPIRES `1
USE PERMIT 74/
ZONE NUMBER -2-C)DI-i qo,
JOB SUITE/APT#
ADDRESS � C__
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO
1 '75
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LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
iEscp Approved 0
RW Permit Requited (3
Street USo Permit Roq'd 113
EXISTING - PROPOSED
Inspection Required
Sidowall, Requited
REQUIRED DEDICATION- FT
Underground E3
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
13
7NO.
YES NO
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ADDFAS� 44
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CITY ZIP TELEPHONE
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kSTATE LICENSE NUM13ER EXPIRATION DATE CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO
NEW
XF
ESIDENTIAL
ADDITION
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COMMERCIAL
REMODEL
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MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINES§�,OFI ACTIVITY) EXPLAIN:
luulil NUM13ER NUMBER OF
OF DWELLING
STORIES UNITS
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
SHORELINE OR ADB# T INSPECTION BOND
REO'D POSTED
10YES ONO S
ALLOWSIGN AREA HEIGHT
E D PROPOSED ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY D ATE CL
REO'D I PROVIDED
REMARKS
OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED ' I LOAD
YES
REMARKS z
1PROGRESS INSPECTIONS PER UBC joa/ IBC109 / IRC109 FINAL INSPECTION REn,n a
CHECKED BY ITYPE
HEAT SOURCE
GLAZING %
LOT SLOPE %
ECK NO:
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t:
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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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
2
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMI1 SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABIL11Y 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 VIOLATIO�N�F T1 E I -ABOR C ODE OF THE STATE OF WASHINGTON RELATING TO
WummrN a 0 ENSATION INSURANCE AND RCW 18.2T
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DATE�IGNTD
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FALLIATION
Description
FEE
Description
FEE
�lan Check
State Surcharge
3uilding Permit
City Surcharge
Diumbing
Base Fee
Aechanical
3rading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
Building ouicial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
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ATTENTIOW-) Wk I I jjj
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCYHAS BEEN GRANTED. UBC109jlBC1I0/IRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW-INSVECTC
PINK -OWNER GOLD -ASSESSOR
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SETBACKS:
FR0NT,_2z92L_____,,__ MAXIMUM IVEWAY 05E
N N N
SIDE
e,;ft' 4L(*ED 14% N
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REAR
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ALL EXPOSED OURFACES, TO cw 0 �_j
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BE COVERED WITHIN 2 DAYS C. TUCK
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INSPECTIONS REQ'D. C-0QL4Sc,-T-%oKJ
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ........... z
0
-4
Slab Insulation ..........
0
ITI
PLUMBING:
Underground .............
CD
Rough -in ...................
M
C
M
Commercial Final ......
0
0
0
HEATING: C
3: ITI
ITI
Gas Test ....................
z
Gas Piping ................. C z
r
Equipment .................
-n
Commercial Final ....... 0
EXTERIOR SHEATHING x C
NAILING .......................... M M
0 6
FRAMING ........................ 0 r-
0 ITI
C
CD
FIRST FLOOR FRAMING... C CD
M 0
Z
INSULATION ................... -A
Floor Insulation .........
3:
Wall Insulation ........... >
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Ceiling Insulation ....... --I
SHEETROCK NAILING ... C/)
z
0
SPECIAL INSPECTION --I
IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The Initials MTare Miltoll
T110111PS011,',1, tcllll)01*,II*Y c011tl*,Ict
ilispcctor for the City.