20040856.pdfERMIT EX
FP PIRES
DATE RECEIVED
CITY OF EDMONDS
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PERMIT
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CONSTRUCTION PERMIT APPLICATION
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OWNER
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PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
PE 921\j OIL U E L
LID FEE $
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required E3
EXISTING — PROPOSED
Street Use Ponnet Roq'd (3
inspection Require of 0
Sidewalk Required [3
CITY ZIP
TELEPHONE
REQUIRED DEDICATION— FT
Undergrrrund
Wiring required 13
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO 13 z
ADDRESS
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REMARKS z
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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STATE LICENSE NUMBER EXPIRATION DATE BY REO'D POSTED
OL4AW1 rily?U11) L'2-6- 0 /,, SEPA REVIEW SIGN AREA EIYES ONO S HEIGHT
PROPERTYTAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
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EXP
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR z
ADDITION PKr COMMERCIAL z
CHANGEOFUSE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED IL
GRADING FENCE
REPAIR CYDS D ( X Fr) REMARKS
OTHER
DEMOLISH El TANK M
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT E] ROCKERY El FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY I TYPE O�CWJF OCCUPANT
WE 71 GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING fr)r- AREAS SPECIALINS ECTION JAREA OCCUPANT
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NUMBER rlir LOAD
0 STORIES UNITS REQUIRED [3 YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPEC11ONS PER UBC 108/IBC109/iRC109 FINAL INSPECTION REO'D
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Description FEE Description FEE
Plan Check State Surcharge
HFAT SOPRCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
PLAN CHECK NO: Oq __qq (0 VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO /W
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Uj PERMIT APPLICATION: 180DAYS
PERMIT LIMIT' I 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
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
!3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
ml Recording Fee Receipt 0 Ll (I
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED 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 COMPENS�=NCE AND RCW 18 27. OFFICIALS SIGNATURE DATE
SIGNATO' (OWNER 0 DATE SIGNED (425)
T'11
2 771-0220 RELEASqD B )DATE
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ION EXT 1333
ITISU , NLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
:4 4CTORi
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- IqINAL - FIL_ YELLOW INS
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PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK I - OWN)ER 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 ...........
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 ..................
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