20040797.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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NAME
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ADDRESS
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ZIP TELEPHONE
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PERMITEXPIRES
U�F PERMIT
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NUMBER
JOB SUITE/APT#
ADDRESS M7 -7 4ve
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Raq'd
EXISTING - PROPOSED Inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 13 NO 13
REMARKS
OWNER/CONTRACIFOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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X SEPA REVIEW SIGN AREA HEIGHT
PT ALLOWED PROPOSED ALLOWED OPOSEO
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P OPERTY *X ACCOUNT PARCEL NO. COMPLETE EXEM
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NEW RESIDENTIAL El PLUMBING MECH ALLOWED PROPOSEP NTt::-8i&E5ME*
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PARKING LOT AREA PrNNING RMEVIEWE DATE
MULTIFAMILY SIGN REQ-D I pRQXIDED
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REPAIR GRADING In. Y ns, I X FT) REMARKS
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DEMOLISH El TANK
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS 0 CT[VITY) EXPLAIN: ---
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DESCRIBE WORK TO BE DONE
REMARKS
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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 7/L57 State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
HECK NO: VESTED DATE Plumbing Base Fee L7,5 L�)
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 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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It. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'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 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 MODIFV� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due Lj
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Recording Fee Receipt #
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1 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
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 LAI3ORC43tQE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIOrSURNNCE AND RCW 18,27. OFFICIALS SIGNATURE DATE
SIGNATURE (OWNER OR A ENT) DATE S (425)
r A I fENT) A )GNED
\j 771-0220 RELEASED
ATTENTION Off 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIG11'
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
YELLOW-INSPECYC
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
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SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
0
Underground .............
0
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Rough -In ...................
Commercial Final ......
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3:
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HEATING:
M 0
0
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GasTest ....................
0
Gas Piping .................
3: M
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
0 -n
NAILING ..........................
FRAMING........................
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FIRST FLOOR FR AMING ...
0
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INSULATION ...................
C CD
9 CD
Floor Insulation .........
Q 0
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Wall Insulation ...........
X
Ceiling Insulation .......
3:
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
3:
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MISCELLANEOUS ..........
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FINAL APPROVAL FOR
OCCUPANCY ..................