20040825.pdfDATE RECEIVED [PERMIT EXPIRES E2_
CITY OF EDMONDS
AE PERMIT
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NUMBER
CONSTRUCTION PERM IT APPLICATION
JOB
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ADDRESS/ OITE/APT#
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DIN /NAME OF;
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
MSINSS
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MAILING ADDRESS
140
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved E3
RW Permit Raciuved E3
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EXISTING — PROPOSED
Street Use Permit Soq'd E3
Inspection Required E3
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Sidewalk Raquired E3
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REQUIRED DEDICATION� IFT
Underground
1
wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES 11 NO 13
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ADDRESS
REMARKS
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OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY
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REQUIRED SETBACKS (Fr.)
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PROPOSED SETBACKS (Fr.)
FRONT UR SIDE REAR
PROPOSED
SIDE
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COMPLIANCE OR
E] ADDITION COMMERCIAL
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CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY
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GRADING FENCE
REPAIR CYDS ( X Fr)
REMARKS
DEMOLISH 1:1 TANK o OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
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STORIES
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NUMBER
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DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/[RC109 FINALINSPECTION REQ'D
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VALUATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
URCE GLAZING'% SLOPE %
Building Permit City Surcharge
K NO: VESTED DATE
Plumbing Base Fee *�2n, on
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
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review Plan Chk. Deposit
IN INTERE�T.' AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 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 INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
659,f
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION A ROVAL
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-
This application is not a permit until signed by the
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknow!cdged in space provided.
WORKMEN'S COM PEN SATIONALSU RANCE AND RCW 18.27.
OFFICIALS PIGN14URE DNFE
SI=OWNER 0 G T) DATE SIGNED
(425)
771-0220 b- V _1DATF
REIE
A17ENTION
E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
ORIGINAL-FILE YELLOW- INSPECTOR
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 ................. z
0
Retaining Wall ........... --I
0
Slab Insulation ..........
PLUMBING:
Underground .............
0 M
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Rough -In ................... M
0
-40
Commercial Final ...... 0 C:
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HEATING: M Z
GasTest ....................
Gas Piping .................
Cn
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Equipment ................. 0
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Commercial Final ....... -4
M M
EXTERIOR SHEATHING
NAILING .......................... 0
0 rn
FRAMING ........................ cf)
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M 0
FIRST FLOOR FRAMING ... Z r-
INSULATION ................... X
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation ....... Cn
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR L C5
OCCUPANCY ..................