20040822.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
PERMIT EXPIRES
USE PERMIT
ZONE NUMBERI't�
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PLAT NAMEISUBDIVISION NO. 0 =TN 0. +LID NO.
LOT
LID FEE $
TESCP Approved I
PUBLIC RIGHT OF WAY PER OFFICINL STREET MAP RW Permit Required 'r
Street Use permit Roq'd
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inspection F squired
pe Is
EXISTING � PROPOSED R ad
Sidewalk Required
underground
REQUIRED DEDICATION� FT Wiring required
METER SIZE NO. OF FIXTURES PRV REQUIRED
I YESM NO 13
REM,
ADDRESS I OWN
CITY ZIP TELEPHONE -pressure/rPlief volve, an approv
PHONE CBL 0 4 listed expansion tank shall be
installed on all hot water tanks.
? ENGI I" �E6"D BY
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ADDRESS
FIRE REVIEWED 13Y
Z1P_j I TELEPHONE
17 J'go& 2�t/�
1 STATE LICENSE NUMBER L, RATION DATE CHECK 8
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PROPERTY TAX
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NEW
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ADDITION
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REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE 0
,f USE, I
PARCEL NO.
XRESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
' OR ACTIVITY) EXPLAIN:
uJi NUMBER NUMBER OF
0 OF DWELLING
M
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
0�
6t:
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
FT)
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
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 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 INDEMNIFN� 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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIF71� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY I'D ENFORCE ANY ORDINANCE PROVISION."
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LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
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DATE UJI
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BOND
POSTED
47HE—IGH—T
iWED PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS tFT)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
CHECKED BY I TYPE OF
SPECIAL INSPECTION JAREA
REQUIRED 0 `1
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
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PROGRESS INSPECTIONS PER UBC 108 / IBC1 09 / IRC1 09 FINAL INSPECTION REO'D
VALUATION
Description
Plan Check
Building Permit
plumbing
Mechanical
Grading
Engr. Review
Engr. inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
['TG',IVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
I
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
T
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
LATING TO
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RE
WORKMEN'S COM PEN SATjPN- INS.0 RANCE AND RCW 18.27. 1
D TE.SIGNED
X) j
CALL
FOR INSPECTI
(425) -
771-0220
r. VT 1 11 01 11
FEE
FEE
:ADescription
State Surcharge
City Surcharge
c) Base Fee
! Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
PP
Pla Chk,
Depo.
A I� N R VAL
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and Fees are paid, and
pace Provl 0
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L�This application is not a permit until signed by the
Building official or his/her Deputy: and Fees are paid. and
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eceipt is acknowledged in space provided.
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F1 ASED BY
)INTENTION
IT I S U N LAWFU LTO U SE OR OCCU PY A BU I LDI NG OR STRUCTU R E U NTI LA F1 NAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC 109 / IBC1 10 / IRC1 10.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ................... I....
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
IDS
OCCUPANCY ..................
The initials MT are Milton
ThOl"Pson, a tcniporary contract
inspector for tile City.
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