20040794.pdfDATE RECEIVED
PERMIT EXPIRES
CITY OF EDMONDS
U SE PERMIT
ZONE NUMBER ()7!/
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAM E/SUBDIVI SION NO.
LOT NO.
LID NO.
LID FEE S
MAILING ADDRESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW permit Required E3
EXISTING — PROPOSED
Street Use Permit Roq'd E3
inspection Required [3
Sidewalk Required 0
CITY ZIP EPHONE
REQUIRED DEDICATION— FT
underground
Wiring required [3
NAME
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ENGINEERING REVIEWED BY DATE
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SIGN AREA
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ALLOWED PROPOSED
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NEW hESIDENTIAL hUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FF.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT L/R SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
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REMODEL MULTIFAMILY SIGN
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LOT AREA
PLANNING REVIEWED BY DATE
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REMARKS
DEMOLISH TANK OTHER
E]GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT
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ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTivirf) EXPLAIN:
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REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'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
City Surcharge
K NO: VESTED DATE Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN Grading
(CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
uj PERMIT APPLICATION: 180 DAYS
IL
PERMIT LIMIT 1 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORJK AUTHORF!D THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/tier Deputy: and Fees are Paid, and
VIOLATION IT E�A D
IN IE O'y I 1E STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided,
WORKMEN'S C/44H Tl)��, �INSU C E 18.27.
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QFFICIAL�, SIGN URE DATE
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SIG 'a
NATURE �Vf iEN DATE SIGVED (425)
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771-0220 _T -----
RELEASED BY DA Fl�
A17ENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL --------
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
FANCY 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:
ein9 ...................
Wall ............
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ..........
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ................. a2
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 ..................
T lie Initials MTqre Milto"
ThoiliPson, a telliporary contract
illspector for the CitY-
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