20040761.pdfI
DATE RECEIVED
[PERMITEXPIRES
CITY OF EDMONDS
USE PERMIT
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAME/NAME OF BUSINESS
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PLAT NAMEISUBDIVISION NO. LOT N 7- NO.
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Aw Permit Required
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Inspection Required
EXISTING — PROPOSED Sidewalk Required
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REQUIRED DEDICATION— FT Underground
Wiring required
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NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY RE 10 POSTED
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PROPERTY TAX ACCOUNT PARPEL NO. COMPLETE , EXEM13T ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS IFT) PROPOSED SETBACKS [FT)
NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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NUMBER NUMBER OF CRITICAL
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OF AREAS LOAD
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DESCRIBE W&RK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109 IRC109 FINAL INSPECTION REO'D
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit ity Surcharge
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
06 PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 8APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit I
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt 0
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
9 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.'
9 Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
ING CONSTRUC. This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT CALL Building official or his/her Deputy: and Fees are paid, and
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 FOR INSPECTION receipt Is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 1827. OFFOIALS SIGNATURE TE
SIGNATU /(0 NE V,
OR AGEN DATE SIGNED (425)
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771-0220 RELEASED BY _��/
ATTENTION EXT 1333 ------
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL L�
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
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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