20040842.pdfI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINE'
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MAILING ADDRESS
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CITY ZIP, TELEPHONE
NAME
ADDRESS
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NAME
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ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE PVEI!R9ih1BY
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
V
WPLUMBING/ IECH
ADDITION
F-1 COMMERCIAL
COMPLIANCE( MT___)
F-1 CHANGE OF USE
M]REMODEL
F1 MULTIFAMILY
SIGN
REPAIR
FENCE
( X FT)
F-1 GRADING
CYDS
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUM13ER
OF
NUMBER OF
DWELLING
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AREAS
[
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I L
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES 'TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY 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
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION. -
I a
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 AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION; AND IN D9ING THE WORIS AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION jOF ITHE LAgOLIGODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S cjbMPEN�AT)WIPSYRANCE AND RCW.,18.27.
DATE SIGNED
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ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
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PERMIT K�n
NUMBER , Y� (-1 . c-H _z,
SUITjE/APT#
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LID NO.
LID FEE $
TFSCP Approved 13
RW Perinit Required E3
Street Use permit Req'd 13
inspection Requited E3
Sidawatk Required [3
Underground
Wiring required 13
LOT NO.
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
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METER SIZE LINE SIZE NO OF FIXTURES
Z-
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROLA)RAINAGE
ENGINE
REVIEWED
DATE
FIRE REVIEWED BY DATE
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OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108 / IBC109 if IRC109 FINAL INSPECTION REQ'D
A filln AA11_1 I A 'I it-, i
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
FEE Description FEE
State Surcharge
city Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
03
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SPNATURE DATE,
RELEASED BY
ATTENT40N`_ r.A 1 1%30
ITIS UNLAWFULTO USEOROCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCI10,
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ...........
0
Slab. lr�sbiation ..........
M
PLUMBING:
Underground .............
0
M
C:
Rough -in ...................
M 0
—1 0
Commercial Final ......
0
0 C
HEATING:
M
M Z
Gas Test ....................
10 —1
C —Z
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Gas Piping .................
E:
Equipment .................
0 -n
Commercial Final .......
-n
4
EXTERIOR SHEATHING
M M
NAILING ..........................
C)
0
0 M
FRAMING ........................
C CD
9 (n
FIRST FLOOR FRAMING...
Q 0
Z r—
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION
1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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