20040771.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNM NAIAEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP JTEL�PHONE
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NAME
ADDRESS
CITY ZIP
NAME
ADDRESS
CITY ZIP
STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT-PARQEL NO.
TELEPHONE
CBL #
TELEPHONE
EXPIRATION DATE I CHECKED BY
1:1
NEW
RESIDENTIAL
11
ADDITION
COMMERCIAL
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13
REMODEL
MULTIFAMILY
REPAIR
El
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY)
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NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONEn A.
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14
HEATSOURCr�_. T�f QLAZING%
PLAN CHECK NO:
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
El SIGN
FENCE
( X FT)
OTHER& -I-
FIRE SPRINKLER
FIRE ALARM
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION-
FT
METER SIZE
I LINE SIZE I
NO. OF FIXTURES
I PERMIT EXPIRES
PERMIT
NUMBER ZZ-70-4-/ --,6 7 7
SUITE/APT#
L'L �
LID NO.
LID FEE $
I ESCP Approved
RW Permit Required
Street Use Pannit Roq'd
Inspection Required
Sidewalk Required
underground
Wiring required
PRV REQUIRED
YES 13 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
FIRE REVIEWED BY
DATE
DATE
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EX P I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
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REMARKS
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REMARKS
P 0 S R UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
PROGRESS INSPECTIONS PE
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VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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W PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) "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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHAi L NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 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 AGRiE TO COMPLY WIT 11 CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE VVYRK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE 4B9R CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S CQMj'1�NSAjIOI`j INSURANCE�AND RJPW IB 27.
SIGNATURE (OWNE AYE DATE SIGNED
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
ATTENTION I t:)(I
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109!IBC110/IRC110.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
cyl�)
Receipt # .10071
APPLICATION APPROVAL
This application is not a perinit until signed by tile
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided
FFICIALS SIGNArL4RE I DATE ,
HFI,
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Fop;,
ORIGINAL -FILE YELLCW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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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 ..................
The Initials MT are Milt011
Thol"PsOn, a tc,liporary contract
inspector for the CitY-
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