20040813.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
CITY
NAME
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STATE LICENSE NUMBER EXPIRATION ATE K Y
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PROPERTY TAX ACCOUNT PARCEL NO.
C*6 t � j (fC rf) C)5�c TC ! 3
❑ NEW Ea�fiESIDENTIAL
❑ ADDITION ❑ COMMERCIAL
❑ REMODEL ❑ MULTIFAMILY
❑ REPAIR ❑ GRADING CYDS
❑ DEMOLISH ❑ TANK
GARAGE RETAINING WALL
❑ CARPORT ❑ ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVILY) EXPLAIN:
NUMBER [UNITS
R OF
OF ING
OSTORIES
DESCRIBE WORK TO BE DONE
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COMPLIANCE OR
❑ CHANGE OF USE
❑ SIGN
FENCE
❑ ( x FT)
❑ OTHER
❑FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
r� SEPARATE PERMISSION.
¢ PERMIT APPLICATION: 180 DAYS
ru
a PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
a '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
¢ ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.•
x
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION; Y
9 IN DOING THE
�WORK
�AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
w aIkMFN'q COMPENSA710N INSURANCOE THE
CW 18027. WASHINGTON RELATING TO
DATE SIGNE
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JOB 407
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES —'
PERMIT
NUMBER
p^UITE/APT#
1 ^ 1
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LOT I I LID NO.
LID FEE S
TESCP Approved [
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required [
Street Use Permit Roq'd [
EXISTING PROPOSED Inspection Required [
Sidewalk Required [
REQUIRED DEDICATION FT Wirin g required [
METER SIZE I LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES ❑ NO ❑
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERI /I�V�Fk T1..S 8 i`gfjS t• DATE
new ��7i VV ��`` �O !i
FIRE REVI�IGp,(>a(,AVITS / r ECTOR DATE
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VARIANCE OR CU DE iFDBN INSPECTION BOND
j�j REO'D POSTED
OYES ONO S
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REO'D I PROVIDED
REMARKS
CHECKED BY
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED YES LOAD
REMARKS z
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PROGRESS INSPECTIONS PER UBC108/IBC109/IRC109FINAL INSPECTION REQ'D
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing , Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt N
Landscape Insp. Total Amt. Due
Recording Fee Receipt N 1L
APPLICATION APPROVAL
CALL This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in spaceprcvided.
OFFICIALS SSIG/NAT( HE DATE
(425) (cU ('( LlL
771 -0220 RFt FASFD BY DATE
ATTENTION EAT 1333
ITIS UNLA{IUFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTIbN HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC 109 / 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:
Footing ......................
Wall
Pier/Porch
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ... ..........
Commercial Final ......
HEATING:
Gas Test .................... ' ' 1� l ����"�
Gas Piping
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS .......... Q
FINAL APPROVAL FOR /�/�� ! Jr l C l�
OCCUPANCY
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