20040758 (2).pdfDATE RECEIVED
PERMIT EXPIRES
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CITY OF EDMONDS ZONE NUMBER
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NSTRUCTION PERMIT APPLICATION JOB ITE/APT#
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ADDITION
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THIS PE MIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE ONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
I
DO AIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PE MIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLII NT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTE EST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMON:)S, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CU IMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREc rLY
FROM ]HE ISSUANCE OF THIS PERMIT. ISSUANCE OFJHIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIF41T IN ANY WAY TILE CITY'S A131LIlY TO ENFORCE ANY ORDINANCE PROVISION -
I HEREBY CKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
R E By AUTHORIZED AGENT OF
GIVEN IS CORRECT AND THAT I AM THE OWNER. OR THE DUL
I N IS
T TIIEOWNIEI. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONS1RUC-
I I OW
TION; AND IN DOING TILE WORK AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED
TIO V I - L I �N OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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LID NO.
LID FEE S
IESCP Approved
0
RW Permit Required
0
Street Use Permit Roq'd
0
Inspection Required
0
Sidewalk Required
0
Underground
Wiring required
C3
PRV REQUIRED
YES 11 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
GAS PIPE TEST MUST BE
OBSERVED BY CITY INSPECTOR
AFFIDAVITS SHALL NOT
ENGINEERING REVIEWED BY�j- L11 'I'll-P I I- I I DATE
FIRE REVIEWED BY DATE ul
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ALLOWED PROPOSED
ALLOWED PROPOSED
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FRONT L/R SIDE REAR
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OCCUPANT
GROUP
SPECIAL INSPECTION'
AREA
OCCUPANT
REQUIRED
LOAD
REMARKS
z
PROGRESS INSPECTIONS
PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D
3
113
VALUATION throug I Unheated spaceR. IMC 803.2
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
77*1 -0220
FEE Description FEE
State Surcharge
City Surcharge
77T Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a permit Until signed by the
Building Official or his/her Deputy: and Feesare paid, and
provided.
receipt is acknowledged in space
OFFIC#S SIG A YRE DATE
"J/
RELEASED BY i DATG"
A17E TION EXT 1333
ITISUN FULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HA3 BEEN GRANTED. UBC109/IBC110/IRCIIO.
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 .......
FOUNDATION:
ro6ting ......................
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground ............. M
M
Rough -In ................... 0
—1 0
0
C
Commercial Final ...... —49
M M
M z
HEATING:
Gas Test .................... a
Gas Piping ................. Cn
0 -n
Equipment .................
Commercial Final .......
M M
0
EXTERIOR SHEATHING Cn
0
NAILING .......................... 0
M
C/)
FRAMING ........................ W
Q 0
FLO.QR.F.9AMING r
14 ;U
INSULA ib ...
-—Floor. Insplatioo
z
Wall Insulation ........... --I
Ceiling Insulation .......
z
0
SHEETROCK NAILING ... --I
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................