20040753.pdfI
DATE RECEIVED C/
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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CITY ZIP I TELEPHONE
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STATE LICENSE NUMBER
PROPER71 TAX,
ACCOUNT PARCEL NO.
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1:1 NEW
Cq.�,AESIDENTIAL
ADDITION
COMMERCIAL
o MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
o RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVTTYJ EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
I �� I ", +-. "i , *i%,
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
I
PERMITEXPIRES
USE
ZONE
PERMIT
NUMBER
JOB
ADDRESS I: I
SUITE/APT#
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PLAT NAMEISUBDIVISION NO.
OT NO
LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Romilrod
EXISTING - PROPOSED
Street Use Permit Roq'd
inspection Roqwrod
sidewalk Required
REQUIRED DEDICATION-
FT
Undurground
I Witing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
I PRV REQUIRED
YES 11 NO 11
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
7BL
Permit fmm I
Ad 7�9 [ENGINETING REVIEWED BY ef, DATE
I st�.t.-_ .?, ividustri
4ft % _ :'. "? .
)L�
WIVIBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x F-0
OTHER
FIRE SPRINKLER
FIRE ALARM
FIRE REVIEWED BY
DATE
VARIANCE OR CU SHORELINE OR AD1111 I INSPECTION I BOND
REO'D POSTED
OYES 1$
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP T-7: it i ret:
LOT CO %SETBACKS (h)
JEA:Q.. REQUIRED SETBATKS , FTA
ALLOWED M it I Alf". - - V9 1 -1 1 gU Ice. R SIDE REA,�'
! , 1-ousy unheated SPRCP-',-1 JMC 803.2
1h
PARKIN Q_,� L4DT--AR
REO'D I PROVIDEDd- ;T-T
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OCCUPANT;;2
GROUP
CRITICAL
AREAS
NUMBER fQ or-
SPECIAL INSPECTION
REQUIRED
JAREA
OCCUPANT
LOAD
REMARKS
I1HUUKhbb INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D
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 (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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 INDIRECHY
FROM THE ISSUANCE OF THIS PERMIr. 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 ABI1 ITY 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 AGRiE 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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
WORKMEN�S COMPENSATIOW1ft9RANCE AND RCW 18.27.
SIGNATUR1",.1OW7/�R;A,
DATE SIGNED
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 #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
1 his application is not a permit until signed by lite
Building official or hisilier Deputy. and Fees are paid, and
receipt is acknowledged in space provided
OFFIPIALS SIGNAJURE DATE
1 .
T P
RELEASElY 0'
E
A17ENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCIJ-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
1�91JNDATION:
o-Ifocting
"--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
OCCUPANCY ..................
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