20040830.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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STATE LICENSE NUMBER EXPIRATION DATE Y
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MULTIFAMILY
REPAIR
GRADING CYDS
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TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
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FIRE SPRINKLER
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LAT NAMEISUBDIVISION NO.
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LOT NO.
LID NO.
LID FEE $
TESCP Approved
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PU03LIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Permit Required
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Street Use Permit Req'd
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Inspection Required
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Sidewalk Requited
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EQUIRED DEDICATION- FT
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Underground
wining required
M ETER SI ZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
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YES 1:1 NO 13
REMARKS
OWN E RICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING
FIRE REVIEWED BY
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DATE
DATE
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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CHECKED BY ITYPE OF
SPECIAL INSPECTION JAREA -
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REQUIRED [] YES 1 .2
CODE OCCUPA14T
03 GROUP 46
OCCUPANT �
LOAD 12-
REMARKS
PROGRESS INSPECTIONS PER UBC 1081 IBC11 09 / IRC1 09 FINAL INSPECTION REO'D
VALUATION
Description
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Plan Check
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Building Permit
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PLAN CHECK NO: VESTED DATE
Plumbing
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
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
2
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM T IE ISSUANCE OF THIS PERMIT. ISSUANCE OF 'IIIIS PERMIT SHALL NOT BE
Landscape Insp.
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMEW OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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— Recording Fee
FEE
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Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt # Z__ I
Total Amt. Due 7YI-11
Receipt # 2z
2
I IIEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
ING CONSTRUC- This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION Q_F--THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION— receipt is acknowledged In space provided.
WORKMEN'S,rMPElAfATION INSURANCE AND RCW 18 27. OFFICIALS SIGNATURE DATE
SIGNATURE VWNER�R AGENT) DATE SIGNED (425) /)Vo!�— e7-1-
",3 '-NSL 1�1 - \4 - o iA 771-0220 RELE
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ATTENTION Off 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.
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 ....................
Gas Piping .................
Equipment.................
Commercial Fi6a'I .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................ WAS
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ... M-S
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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