20040839.pdf4
DATE RECEIVED
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PERMIT EXPIRES
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CITY OF EDMONDS
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PERMIT
N U M B E R
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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PLAT NAME/SUBDIVISION NO.
LOT Nl/. LID NO.
LM MAILING ADDRfSS
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LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL
TESCP Approved
STREET MAP RW Permit Required [3
[3
Street Use Permit Roq'd
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EXISTING — PROPOSED inspection Requi ad C3
Sidewalk Required C3
REQUIRED DEDICATION—
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FT Wiringroquired C3
NAME
METER SIZE LINE SIZE
NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
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REMARKS
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ENGINEERING REVIEWED BY
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FIRE REVIEWED BY
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am VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
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REO'D POSTED
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PROYERTYTAX ACC NT RCEL NO.
SEPA REVIEW
COMPLETE EXEMPT ALLOWED
SIGN AREA HEIGHT
PROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR
13 ADDITION COMMERCIAL CHANGE OF USE
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REMODEL MULTIFAMILY
PARKING LOT AREA PLANNING REVIEWED BY DATE
REQ'D PROVIDED
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1:1 SIGN
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1:1 REPAIR GRADING FENCE
CYDS ( X FT)
REMARKS
1:1 DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS=:
CHECKED BY TYPE
OCCUPANT
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NUMBER 17,4— NUMBER OF CRITICAL
OF 14 AREAS
SPECIAL INSPECTION
OCCUPANT
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STO "40 NITS NUMBE
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JAREA
REQUIRED [ YES
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DESCRIBE WORK TO 6E DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 10811131101109/1FIC109 FINAL INSPECTION REQ'D
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VALUATION
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Description
FEE Description FEE
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Plan Check
State Surcharge
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Building Permit
City Surcharge
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VESTED DATE
PLAN CHECK NO: 14 -
Plumbing
Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED THIS PERMIT COVERS WORK TO
t: 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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Engr. Review
cc PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
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 DIREC rLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 7HIS PERM11 SHALL NOT BE
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Total Amt. Due
D DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Recording Fee
Receipt # C:�
I HEREBY 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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CALL
This application is not a permit until signed by the
T TION; AND JN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
'ON ' AN
Building Otficial or his/her Deputy: and Fees are paid, and
I'N VIOLfirTIQN OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
I V to
FOR INSPECTION
receipt is acknowledged in space provided.
WORK)&N�S COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURL DATE
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771-0220
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RELE D BY TE
ATTENTION
EXT 1333
UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
ITIS
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCLI-
ORIGINAL -FILE YELLOW- INJECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
PINK -OWNER GOLD -ASSESSOR
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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:
Gas Test ....................
Gas Piping .................
Equipment .................
Final
Commercial .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR In 1'—
OCCUPANCY ..................
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