20040855.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP TELEPHONE
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NAME
ADDRESS
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STATE LICENSE NUMBER EXPIRATION DATE I ,GH;Cnr[�,BY
PROPERTY TAX ACCOUNT PARCEL NO.
11
NEW
-a�RESIDENTIAL
AT-VL& BING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
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MULTIFAMILY
SIGN
REPAIR
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GRADING
CYDS
FENUI:
( x FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) �ALAIN:
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS I NUMBER
DESCRIBE WORK TO BE DONE
I
L PERMIT EXPIRES
USE PERMIT
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NUMBER
JOB SUITE/APT#
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PLAT NAM E/SU BDIVI SION NO. LOT NO, LID NO.
LID FEE S
TUSCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Parnilt Requited [3
street use Permit Roq'd 0
EXISTING — PROPOSED inspection Required 13
Sidewalk Required 13
Underground
REQUIRED DEDICATION— FT wiring required C3
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METER SIZE LINE SIZE T—NO. OF FIXTU 3 PRV REQUIRED
YES 13 NO 13
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ACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE C5
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ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
BY
DATE
DATE
SHORELINE 08 ADB# _I INSPECTION I BOND
REO'D POSTED
OYES ONO $
GN AREA HEIGHT
FA L L 0 WSED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED BY I TYPE
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA vu�urm
REQUIRED 0 YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D - a
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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
E EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. AR13ING DIRECTLY oil INDIRECTLY
1: FROM THE ISSUANCE OF 'THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
3 DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
-A -
D NOR LIMIT IN ANY WAY THE C11YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0 Qj
Recording Fee Receipt # 14
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- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official 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. 0 FICIA -SIGN TUBE JAT.E,
�JGNAT,LJRE (OWNER OR AGEN DATE SI NED
(425)
]j( 46 771-0220 "REt . A a Y oi�/] DAT
1 77
ATTENTION EXT 133 7/ -A
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL Mf(I(I '� /(1 1 f —
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ........... z
0
Slab insulation ..........
PLUMBING:
Underground .............
Rough -In ................... M
0
Commercial Final ...... —40
0 C
HEATING: 4 K
3: M
M z
Gas Test ....................
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Gas Piping ................. >
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Equipment .................
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Commercial Final ....... -n
EXTERIOR SHEATHING
NAILING .......................... M M
FRAMING ........................
0 M
C C#)
FIRST FLOOR FRAMING ... co
M 0
Z
INSULATION ...................
Floor Insulation ......... ;0
3:
Wall Insulation ........... >
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Ceiling Insulation ....... __I
:E
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... _11
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................