20040792.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
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ZIP I TELEPHONE
PERMIT EXFIIRES_�
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PERMIT
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NUMBER
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PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE- S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW P0tZPRVq0,d,1ed 0
mit Hatt'd E3
street use permit R80
Inspection iiequired 19
EXISTING PROPOSED Siciewalk Hurtueed
underground
RFQUIRED DEDICATION FT wiring required E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO 13
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REMARKS
OWNER/CON TRACI OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME <
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ADDRESS 'FE
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CITY TELEPHONE
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STATE LICENSE NUMBM EXPIRATION DATE xI\CHECKEq,,BY
1OPERTY TAX ACCOUNT PARCEL NO. —
NEW
RESIDENTIAL
El
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
E3
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS,O
, P ACTIVITY) qXPLAIN
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
E:iFENCE
( X FT)
OTHER
EFIRE SPRINKLER
:I FIRE ALARM
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP K
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDEDL_
NUMBER
NUMBER OF
C
CRITISAL
OF
STORIES
DWELLING
UNITS
AREA,
NUMBER
N�
I
DESCRIBE
WORK
TO BE DONE
REMARKS
CHECKED BY ITYPE
DATE
410 �;Z,
DATE
SHORELINE OR A111111 INSPECTION BOND
REC
POSTED
OYES aNO IS
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
q
0"
, 3,
10K_
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA "NING
SPECIAL INSPECTION JAREA
REQUIRED [] YES
DATE
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OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINALINSPECTION REQ'D
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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 N
CE L
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECftYOR INDIRECTLY e� Es
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF [[ITS PFFAMIT SHALI N01 BE Landscapelnsp. Total Amt. Due
a
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILI 1Y 10 ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt # ILI
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknovv,�dged ill space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. OF - TAT 'IGNATURE D E
SIGNED
SIGNA'ruFjff�jbWNEFI OR AGENT) I
DATE
4 21 771-0220 R71iFD 13Y
DATE
ATT-ENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL I
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOILD-ASSESSon
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:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
WIL -:3 - n<
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
so
The Initials MT are Milton
Thompson, a temporary contract
inspector for the City.
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