20040806.pdfDATE RECEIVED
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PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE
NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION
'ON
'ATPUBLIC
ADDRESS 6'
OWNER NAM FiNAME OF BUSINESS
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
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MAILING7 ADMIESS LID FEE S
0
TIESCP Approved
RIGHT OF WAY PER OFFICIAL STREET MAP FIW Permit Required
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C) R�4
Street Use Permit Flori'd C3
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Required 0
Sidewalk Required 13
7 REQUIRED DEDICATION- FT Underground
Ll -7-7 1 - Ilk) -7, 1 I witing tectuirao 13
:2, -
NAME METER SIZE LINE SIZE NO. OF FIXIURES PRV REQUIRED
YES 0 NO 0
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ADDRESS REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
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CITY EPHONE
NAME CBLP
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ENGINEERING REVIEWED BY DATE
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ADDRESS
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FIRE REVIEWED BY DATE
0
CITY ZIP i TELEPHONE
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VARIANCE OR Cu SIIOIIELIlIE70R 7ADB# INSPECTION BOND
STATE, LICENSE NUMBER EXPIRATION DATE C BY REQ'D POSTED
OYES ONO S
P'T 0 0 9
1 SEPA REVIEW SIGN AREA HEIGHT
C OUNT PA EL NU. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX A'C
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EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW X RESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
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0
CHANGE OF USE
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY REO'Dj PROVIDED
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SIGN
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REPAIR GRADING CYDS FENCE
X FT) R KS C"
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DEMOLISH TANK Ono 11 .1 �
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Ei GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
0
ITYPE OF USE, BUSINESS OR ACTrVIT'O EXPLAIN:
0
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CHECKED 13Y �;C�N[
rTr PANk-�-,)
fun F GROUP
10
NUMBER NUMBER OF CRITICAL
93
OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
0
STORIES UNITS NUMBER REQUIRED [:] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING '16
LOT SLOPE %
Building Permit_
City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOFIS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMI ESS 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 INDIRFCIIY
FROM THE ISSUANCE OF THIS PERMIT! ISSUANCE OF THIS PERMIT SHAI I Not HE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE ciryS ABILI1Y TO ENFORCE ANY ORDINANCE PROVISION
x I 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 DULY AUTHORIZED AGENT OF APPLICATION APPROVAII
I hisapplication is not a permit until signed by the
THEOWNER I AGREE TO COMPLY WIIII CITY AND STATE LAWS REGULATING CONSTRUC Building Officai or hisilier Deputy and Fees are paid, and
TION, AND IN 02W�Q�JT!ILE ORK AUTIIOHIZED THEREBY, NO PERSON WILL BE EMPLOYE CALL
IN VIOLATIOI T1 AWB 0 R CODE OF THE STATE OF WASHINGTON RELATING F/0 R INSPECTION receipt is acknowledged in space provided
11
WORKMEN'i/F�PEN')�ION INSURANCE AND RCW 18 27, 1 OFFIgA S G I UR ATE
SIG ATURE (1WN T) DATE SIGNED
(425)
771-0220 HF-i FASF0 hY DATE
AT ENTION E)ff 1333.,,"
IT IS LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTUR UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CE IFI- Offl(IINAL FILE YELLO�V - INSPECTOJI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 Pl%�, CWiNEH COLD ASSESSOF3
04,02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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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 ..................
go(v
-rjje 111itials MT are Milt011
Tholl,I)sOrl, a telliporary col'tract
ilispector for the CitY-
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