20040814.pdfI
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY
NAME
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CITY
NAME
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ADDRESS
Iliffi; 081 W "VFA 11101 ZMA I MAI
ZIP T LEPHONE
ZIP TELEPHONE
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PERMIT EXPIRES
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USE PERMIT
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ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO
LID NO,
1
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Ariproved
RW Permit Required
Street Use Poreril Hnq*d
EXISTING — PROPOSED
Inspection Required
Sidewalk Required
R P EQUIRED DEDICATION- FT
Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES
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PRV REQUIRED
STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO
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ti 16 0
NEW
RESIDENTIAL
PLUMBING / MECH
0201**C
0 OMMERCIAL
COMPLIANCE OR
OF USE
(ErADDITION
CHANGE
REMODEL
4 MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( x Fr�
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
RPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
ER MBER OF CRITICAL
UM
U
iNG AREAS
LU NUMB
M OF V41 DWEI I
U W IT HAk
0 STORIES N NUMBER4;79
DESCRIBE WORK TO BE DONE
HEAT SJURCE GLAZING % LOT SLOPE %
PLAN 6H�ECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL. NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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 AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V61LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
DATE S19NED
T
SIGNATU,Ki (OWNER OR 7ENT�)) .
YES 13 NO El
REMARKS
OWNER/CONTRAC10H RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DAT E
FIRE REVIEWED BY DATE
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INSPECTION
BOND
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SEPA REVIEW SIGN AREA
HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE REOUIRED SETBACKS (IT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR
FRONT L/R SIDE REAR
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PARKING
LOT AREA_[4PKANjNINjG
REVIEWED BY DATE
REQ'D I PROVIDED
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REMARKS
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CHECKED BY CCUPANT
GROUP 12.
JTY STRUCTION 0 JA--
SPECIAL INSPECTION JAREA UUL;UFAN1
REQUIRED [3 YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE�
Fire Review PlanChk.Deposil
Fire Inspection Receipt #
LandscapeInsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building o6cial or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFT`Iq�!��Jj- SIGA� I URF DAIE
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771-0220 HF1 SED B /DATE
ATT KITInhi r.A 1 1%3%3%3
ITISUNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC1109/IBC1l0/lRC110- Ir e%
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
111GINAL - FILE YELLA - /SPECTC
PINK OWNER GOLD - ASSESS013
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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 ..................
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