20040796.pdfDATE RECEIVE
CITY OF EDMONDS 1
CONSTRUCTION PERMIT APPLICATION
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NAME
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STATE LICENSE NUMBER
EXPIR TION DATE
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NJO.
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NEW RESIDENTIAL
PLUMBING MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
GRADING FENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK
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GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Aw Permit Required
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street Use Permit Roq'd
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EXISTING - PROPOSED
inspection Required
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REQUIRED DEDICATION- Fr -
underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13
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REMARKS
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OWN Eq/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DAT E
FIRE REVIEWED BY DATE
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VARIANCE OR CU ffRELNE& A660
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SEPA REVIEW SIGN'AREA HEIGHT
COMPLE.TE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP 35 to,-6/1
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROP CIS ED _SETBACKS (FTF.)
ALLOWED PROPOSED. FRON�- SIDE REAR FRONT
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SPECIAL INSPECTION JAREA uuuur^ivi
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IPROGRESS INSPECTIONS PER UBC 108 1 IBC109 / IRC109 FINAL INSPECTION FIECI'D
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Description F E;E Description FEE
Plan Check State Surcharge
HEAT SMOU ��E GLAZING % LOT SLOPE % Building Permit City Surcharge 5
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PLAN CHY, VESTED DATE Plumbing Base Fee
......... Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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: 180 DAYS
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01. PERMIT LIMIT; I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) Fire Review Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS —7
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 #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREcrLYOR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1HIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due 2-5 Lr.
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01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION' -2�lez,
x Recording Fee Receipt # [4 -�
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 DU& AUTHORIZED AGENT OF I his application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC- 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 18 2T OFFICI -�s S I G N71 DAIE
S:a(OWNER OR/AGENTY DATE SIGNED (425)
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771-0220 -TF-F E--D -BY- -2DATE
ATTENTION EXT 1333 ox e,
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IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
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INSPECTION HASBEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU ORIGINAL FILE - YELLOW SPE04R
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK-OVVNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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WPR E Y PLANNING
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1 9, 2004
PE". R M 1 T C, 0 U N TE R
CITY COPY
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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