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IDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
CITY ZIP TELEPHONE EXISTING - PROPOSED
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NAME I METER SIZE LINE SIZE NO. OF FIXTURES
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CITY ZIP I TELEPHONE
15C6
ADDRESS
110-2
CITY
STATE-LltENSE NUMBER
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PROPERTY TA)( ACCOUNT.PA
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TELEPHONE
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PERMIT EXPIRES
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LUSE PERMIT
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JOB SUITE/APT#
ADDRES'S
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE S
IESCP Approved
RW Permit Required
street use Permit Req'd
Inspection Required
Sidewalk Required
Undergfound
Wiring required
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
DATE
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SIGN
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REPAIR
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CYDS
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DEMOLISH
TANK
OTHER
GARAGE
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NUMBER
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PLAN CHECK NO:
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 100 DAYS
W
C. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CIFY OF
N EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIREC FLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
C,
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 AGEN1 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIPMOYWkURANCE AND RCW 18.27.
DATE SIGNED
IN
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
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REMARKS
BY ITYPE
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SPECIAL INSPECTION AREA UGGLIPAN F
REQUIRED LOAD 1
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PROGRESS INSPECTIONS PER UBC 108 / IBC1 09 / IRC1 09 FINAL INSPECTION REO'D -
VALUATION
$ U -FU
1' , L4"
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State surcharge 14'.
City Surcharge_
Base Fee
Plan Chk. Deposit -'7q
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or hiSjher Deputy: and Fees are paid, and
(ec-,,ipt is acknowledged in space provided,
NAT E DATE
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ELEASED BY, DAlt
ATTENTION '�/
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL L I
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIG11'
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FIT L PROJECT APPROVAL Z)RM
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BUILDING DIVISION
MEMO TO: PE7?
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FIRE DEPARTMENT DATE
FROM:
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ENGINEERING DIVISION DATE--
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DESCRIPTION OF WORK TO BE INSPECTED
A field inspection was conducted to determine final compliance with approved plans. Final approval
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denotes that there' are no objections from the above signed Department to the release of
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PERFORMANCE BONDS and the granting of:
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u Copy of CORRECTION NOTICE given to owner/contractor by inspector
RECEIVED
DEC 2 2 20011
2.
PERMIT COUNTFr
3.
RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Si
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
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Pier/Porch .................
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Retaining Wall ........... M
Slab Insulation ..........
PLUMBING:
1711
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Underground ............. M 0
0
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Rough -In ................... 0
Commercial Final ...... :E M
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HEATING: r)
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Gas Test ....................
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Gas Piping .................
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Equipment ................. -.4
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Commercial Final .......
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EXTERIOR SHEATHING 0 r-
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NAILING ..........................
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FRAMING ........................ M 0
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FIRST FLOOR FRAMING... 71
INSULATION ...................
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Floor Insulation ......... z
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ... 0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. -�7
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