20040759 (2).pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS
eR-T44
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP [TELEPHONE
NAME
CEIL
ADDRESS
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CITY
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ZIP
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TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE.
CHECKE D BY
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PROPERTY TAX ACCOUNT PARCEL NO.
6 D Do cf, C)
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0 NEW
RESIDENTIAL
X PLUMBING / MECH
11 ADDITION
COMPLIANCE OR
COMMERCIAL CHANGE OF USE
REMODEL
MULTIFAMILY
F-1 SIGN
REPAIR
GRADING
l [D FENCE
CYDS ( X. FTI
E] DEMOLISH
TANK
m OTHER
GARAGE
13 CARPORT
RETAINING WALL E] FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
DWELLING
CRITICAL
AREAS
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
rt
HEAT SOURCE
PLAN CHECK NO:
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
N U M B E R -,71
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT -
NO �OFFIXTURES
METER SIZE LINE SIZE
SUITE/APT#
//" �� -z�' /
LID NO
LID FEE $
ILSCP APPIM011
RW Potent Rocitmod
Street use polent timi'd
inspection Roquilud
sidewalk HoCilillild
underground
wiling Inquired
PRV REQUIRED
YES 0 NO 1:1
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
GAS PIPETE
I T c I I yy I imNi
ENGINEERING REVIEWED BY br. fAkildr-11" I CLJ DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
SHORELINE OR ADB# I INSPECTION BOND
I Q
3 E O6'DD POSTED
OYES ONO S
SIGN AREA LLO HEIGHT
PROPOSED
ALLOWED , PROPOSED ALLOWED I
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REQUIRED SETBACKS (Fr.) PROPOSED SE BACKS Fr' I
FRONT UR " 15
FRONT SIDE REAR IDE REAR z
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LOT AREA I PLANNING REVIEWED BY JE a.
CHECKEDBY ITYPEOF
CO E - OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPA1,11
LOAD
[REQUIRED 11 YE
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REMARKS z
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ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
-in
4r_,.q--r oil fuel- urning_aapppplianecees passing
IMC $03.2
VALUATIO'Ithrougl unheated spaces.
$ ____ I
GLAZING %
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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 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 NATURE, ARISING DIRECTLY OR INDIREC FLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI JNE URANCE AND RCW 18.27.
AT
SIGNejJRE (OWNER OR(GENT) D -- E SIGNED
A C. k",
Description
Plan Check
Building Permit
plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
FEE Description FEE
State Surcharge
city Surcharge
`7
CALL
FOR INSPECTION
(425)
771-0220
Plan Chk. Deposit
E[R EE —
eceipt N
Total Amt. Due
Receipt # P
APPLICATION APPROVAL
This application is not a permit until sionud fly tho
Building Official or his/tier Dopuly� and Foos tire Paid. and
receipt Is acknowledged in space PlOVidild
1`41(al S SJIQNATURE DA 117
A17ENTION FZA 1 1%3%30
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
BY / - PAW
0111GINAL FitE YELLOW INSPIC.101t
PINK-OWNE11 GOLP
GREEN ACCOUNIING
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INSPECTOR
DATE APPROVED
SETBACKS .......... ........... ..
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
-2— - a,
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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nic Initials PAT are Milton
Tholilpson, a tcniporary contract
inspector ror the City.
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