20040854.pdfW
DATE RECEIVED
USE
CITY OF EDMONDS ZONE
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS
f7y;�E OF BUSINESS
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ADDRESS
CITY
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
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PROPERTY TAX
ZIP TELEPHONE
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RESIDENTIAL
1:1 ADDITION
COMMERCIAL
El REMODEL
&(M ULTIFAMILY
XREPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBER NUMBER OF
OF DWELLING
STORIES 4- UNITS
DESCRIBE WORK TO BE DONE
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PLAN CHECK NO:
PERMIT EXPIRES lffiqliX2
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PERMIT 1�
NUMBER
ei A SUITE/A
lyt�
NO.
Vawveo, PUBLIC RIGHT OF WAY PER OFFICIAL STREEI MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— Fr
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
I ESCP Approved
HW Porrall Requited
Sneal Use Permit Fioq'd
Inspection floquirad
Sidewalk Floquired
Undergroand
Winng required
PRV REQUIRED
YES13 NO 13
REMARKS
OWNERMONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL # I
�Wlo 0 ENGINEERING REVIEWED BY DATE
BY
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
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FIRE REVIEWED BY DATE UJI
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VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
0YES 171NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED I I
REMARKS
CHECKED BY ITYPE OF CONSTRUCTION CODE I OCCUPANT
CRITICAL 1 aV If 0 u PPAP-242
AREAS SPECIAL INSPECTION JAREA occu NT
NUMBER REQUIRED LOAD
F REMARKS
F PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D
VESTED DATE
I
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= 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
CL PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
2 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF W1 IATEVER NATURE, ARISING DIREC TIY OR INDIREC I LY
FROM THE ISSUANCE OF THIS PERMIF. ISSUANCE OF I HIS PERMIT SHALL NOT 13E
_j DEEMED ro MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM TIIE OWNER, OR TliE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
TION; AND IN DOING THE WORK AUTHORIZED TIIEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE L ODE 9,f--
0%%RA-NCI �IIE STATE OF WASIJINGTON RELATING TO
WORKMkWS�OMPEN= I SC AMD RCW 18.27
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
-0
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt
LandscapeInsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/tier Deputy� and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFIC
�t SIG ]URE DeTE
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771-0220 RF-i EASED BY , ... ... DATE/
A-IFT EN1�19N tyk 1 1 JJJ
I.IAtIl /� A/ k
ITIS UNLAW[IldtTOUSE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGIN�L-FIUF_ YELLOW-INSPG TOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PIN� - �drl GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Ell Qd AGCA ;N/ / 1,4 1 DATE_,SIGNED
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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 .................
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 ..................
The Illitials MT are Miltoll
Thompson, a temporary contract
inspector ror tile City.
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