20040846.pdfI
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DATE RECEIV
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA,7E/NAME OFXtINESS
MAILING ADDRESS
/(06 JAJ N/U/7k-17
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NAME
ADDRESS
CITY
ZIP TELEPHONE
ZIP
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STATE LICENSE NUMBER
PROPERT�LTAX ACCOUN
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NEW
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.2r0ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OFaEPSINEC
BU157
NUMBER
OF
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TELEPHONE
� OF
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EXPIRAT17
MICEL NO.
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.'�COMMERCIAL
[] APARTMENT
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GRADING CYDS
TANK
RETAINING WALL
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NUMBEROF
DWELLING
UNITS 0
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HEAT SOURCE I GLAZING %
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.",�PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
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OTHER
RENEWAL
CRITICAL j
AREAS
NUMBER
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PERMIT EXPIRES
U�E PERMIT
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NUMBER
JOB
ADDRESS U0
SUITE/APTN
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PLAT NAMEISUBDIVISION NO
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required 0
Street Use Permit Req d 0
EXISTING - PROPOSED
inspection Required 0
Sidewalk Required 0
REQUIRED DEDICATION— FT
Underground
Wiring required
METER SIZE
LINE SIZE
URES
T
PRV REQUIRED
YES 0 NO 0
PLAN CHECK NO: () ILI — �- I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
A
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
V)
Uj IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
m E, ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS FOR DAMAGES OF WHATEVER NATUR
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANYCITY ORDINANCE
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0 NOR LIMIT IN ANY WAYTHE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
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 DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLAT)PN OF THE LAB9, CODE OF THE STATE OF WASHINGTON RELATING 10
WORKM COMPENSAT14 . IIURANCEANDRC 18.27.
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SIa<Af6Rf (OWNEO OR A�,E / j I DATPJC, A�
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING
FIRE REVIEWED BY
REVIEWED/DATE
DATE
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PROGRESS INSPECTIONS PER UBC 1 08/FINAL INSPECTION REQ'Dj 5
ATtE*TION I 91l il�
IT IS UNLAWFULTO USE 0 UPY A BUILDING OR SrrRUCT1IR&E ULN'TIL
A FINAL INSPECTION HAS) B)EEE MADE AND APPROVAL OR A CERTIFI-
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CATE OF OCCUPANCY HA BEEN GRANTED. UBC SEC
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CALL
FOR INSPECTION
(425)
771 -0220
EXT 333
771-0221
FAX
FEE
APPLICATION APPROVAL
I rils j1pplicalion is not a permit until Signed by the
BmIding Official or his/her DoPutY and Foes ate paid. and
receipt is acknowledged in Space prrvided,
OFFICIALS SIGNATURE DATE
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f:ROM EMERALD AIRE INC. FAX NO. 253e725797 Oct. 04 2004 02: 5GPrl P2
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retainirig Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
-
VNI
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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