20040755.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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STATE LICENSE NUMBER
TELEPHONE
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ZIP I TELEPHONE
ZIP I TELEPHONE
PERMIT EXPIRES
USE PERMIT
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ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved
Rw Permit Required
EXISTING - PROPOSED
Street use Permit Hoq'd
inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
I Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
I PFIV REQUIRED
EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RICA RESIDENTIAL
F1
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
1:1 REMODEL
El MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
1:1
FENCE
( X FT)
DEMOLISH
TANK
19
OTHER
4) k_<11,11C
Ei GARAGE
RETAINING WALL
1:1
FIRE SPRINKLER
z CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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uj NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
0 STORIES
UNITS
NUMBER
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: Ic-, f ; I -. I I VESTED DATE
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THIS PERMIT AUTHORIZES ON& THE W`ORK N6TED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
t: SEPARATE PERMISSION.
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lid 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
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTtY OR INDIREC I LY
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.-
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE [)Ut� AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITIf 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 C5PPENSATION INSURANCE AND RCW IB.27.
SIG�� E�flfi'.OR DATE SIGNED
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YES E3 NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU HORELINE OR ADBI I INSPECTION BOND
REQ*D POSTED
OYES :kNO
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXK ALLOWED PROPOSED ALLOWED PROPOSED
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT, SIDE
,,� REAR,/ F T UP
Iq o/o ,SIDE/REAR/
PARKING LOT AREA NNING REVIFWEP BY DATE
HE IDED
REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION JA
REQUIRED E] YES
OCCUPAP
GROUP
OCCUPANT
LOAD
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REMARKS a
PROGRESS INSPECTIONS PER UBC 108 if IBC1091IRC1 09 FINAL INSPECTION REO'D
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VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
A17ENTION XT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE
Description
-FEE
State Surcharge
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City Surcharge
Base Fee
PlanChk.Deposit C
Receipt 0 ��7
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Total Amt. Due L
Receipt N
APPLICATION APPROVAL
[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.
OFFICIALS SIGNATURE DAT E
R�LEASFD BY DATE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL FILE YELLOVV INSPEZToR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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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
477'
OCCUPANCY ..................
The Initials MT are Milton
Thompson, a temporary contract
ilispector for tile City.
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