20040819.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
,M MAILING ADDRESS
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NAME
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NAME
ZIP I TELEPHONE
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CITY ZIP J1 I TE EPHONE
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ATION
STATE LICENSE NUMBER EXPIR ?� DATE CHEjC BY
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
13
GRADING
CYDS
Fi
FENCE
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DEMOLISH
TANK
DK
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
FlPiSPRINKLER'
FIRE ALARM
(TYPE OF USE. BUS]Wrr /I
, is OR ACTNITY) EXPLAIN:,
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
-I DESCRIBE WORK TO BE DONE
K
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I 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
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I 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
M 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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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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 AGENTOF
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 VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATPV lf4fqURANCE AND RCW 18 27.
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SIGNATTE (OWNER OR A VENJT) DATE SIGNED
A
A �,l IN I A
PERMIT EXPIRES
USE PERMIT q-
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NUMBER
JOB SUITE/APT#
ADDRESS tu
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
LID FEE $
—f—ESC 7PA�PpfolodQ
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required 13
Street u.no Permit Ract'd [3
EXISTING — PROPOSED
inspection Required 13
Sidewalk Required [3
REQUIRED DEDICATION— FT
underground
wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES I PRV REQUIRED
I I YES 0 NO E3
REMARKS
OWNER/C,
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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JCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
SEPA REVIEW SIGN AREA I OYES ONO $ HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (F7) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED By DATE
REQ'D I PROVIDED
REMARKS
CHECKED BY ITYPE OF
SPECIAL INSPECTION JAREA
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTI(
(425)
771-022
OCCUPANTE,
GROUP
OCCUPANT
LOAD
I 08/FINAL INSP
FEE Description
State Surcharge
I City Surcharge
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1 5M
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided. f
h. "7' 1
Ai7E'N'TI0'N Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD . ASSESSOR
GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Mll ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ... ...............
Commercial Final ......
HEATING:
Gas Test ....................
Qr-?
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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