20040870.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
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STATE LICENSE NUMBER EXPIRATION DATE ] c BY
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PROPERTY TAX ACC LNO - n - I -
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
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6PA
120,00MULTIFAMILY
REE I R
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS ORACT[Vrnji��PLAIN:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FTI
OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER CRITICAL
0 OF
AREAS
M -**L- NUMBER
0 STORIES
DESCRIBE WORK TO BE DONE
HEAT SOUR15E GLAZING %
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LOT
PLAN CHECK NO: 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
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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 MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S 5PMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE�&�NEOR AGEqD- DATE SIGNED
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PLAT NAMEiSUBDIVISION NO. LOT NO.
LID NO
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LID FEE S
TESCP APP10vird E3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required Ell
Street Use Permit Roq'd [3
EXISTING — PROPOSED
inspection Required [3
Sajowalk Required C3
REQUIRED DEDICATION— FT
underground
waing requited
METER SIZE
Ll
PRV REQUIRED
YES El NO 13
M
W
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL!DRAINAGE
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REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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VARIANCE OR CU
SHORELINE Oil ADB#
INSPECTION
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PBOND
OS TED
OYES
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SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SET13ACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
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PARKING
REQ'D I PROVIDED
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LOT AREA
PLANNING REVIEWED BY DATE
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REMARKS
CHECKED BY I TYPE OF
CODE OCCUPANT
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SPECIAL INSPECTION JAREA OCUUPA1,11
REQUIRED [ LOAD
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D a
,A
VALUATION
$ -A'm I -
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
Recording Fee
FEE Description FEE
State Surcharge
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City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
nnn
tiEl EASED Y I /Y
ATTMJION CA 1 I%3j%3 11 " 1'.1 " "J 1./ 16)
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UN I ILAFINML
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Chk. Deposit
Receipt #
4-
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisitier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
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RECORD 00 INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
!L ootin il� ..............
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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