20040835.pdfDATE RECEIVED
I ERMIT EXPIRES.
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I LfS E PERMIT
CITY OF EDMONDS ZONE NUMPER
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CONSTRUCTION PERMIT APPLICATION A.DRESSA/ne/oo e- F -
OWNER NAME/NAME OF BUSINESS ae
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
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MAILING AD S 12-'jwA '749/o LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
0 Street Use Permit Roq'd E3
inspection Required
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CITY ZIP TELEPHONE EXISTING PROPOSED Sldrrivall� Requited
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NAME J, METER SIZE LINE SI�E NO. OF FIXTURES PRV REQUIRED C)
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE 5
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
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ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
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GRADING FENCE
REPAIR CYDS X FT) REMARKS
DEMOLISH 1:1 TANK o OTHER
GARAGE RETAININGWALL Ei FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE [] YES
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D S
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % rcharge
4a Building Permit City Su 01-11
PLAN CHECK NO- VESTED DATE Plumbing Base Fee 20
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. 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
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due IL
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0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.,
Receipt
Recording Fee 1 1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP LICATION; THAT THE INFORMATION APPLICATION AWFROVAL
GIVEN IS CORRECT. AND T14AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Olficial 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 acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFICIALS SIGNATURE DATE
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SIGNATU .. /�71`1 OR NT DATE S NED (425) A,
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7 -0220 DATE
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AT'rt0TION E)ff 1333 tlf
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU- ORIGINAL - FILE - YELLOW - INACTOIR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COP,
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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:
GasTest ....................
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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