20040871.pdf7DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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PROPERTY TAX ACCQVNT.E6R
_QEL NO,
E] NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL 13000MULTIFAMILY
WrREPAIR El GRADING CYDS
El DEMOLISH TANK
GARAGE RETAININGWALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR.ACT[VITN% WL�IN:
(A -J PERMIT EXPIRES
Usi PERMIT
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NUMBER
JOB SUITEIAPT#
ADDRESS (,kj
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PLAT NAME/SUBDIVISION NO
LOT NO,
LID NO
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
JESCP Approved
RW Permit Required
EXISTING — PROPOSED
street Use Permit Hoq'd
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Undargroimill
I Winng irequarid
METER SIZE
LINE SIZE
NO. OF FIXTURES
I PRV REQUIRED
3 'L
PLUMBING i MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
I NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES ?.- I UNITS NUMBER
DESCRIBE WORK TO BE DONE
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HEATSOURCE I GLAZING % I I " LOT SLOPE%
PLAN CHECK NO' - VESTED DATE
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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: 180DAYS
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IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
n IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Y
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIT ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO 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 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 SWENSATION INSURANCE AND RCW 18.27.
SIGNATUR�OWN� OR AGENT) DATE SIGNED
19-3 -N --oili
YES [I NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
RECIT)
POSTED
[]YES A49-is
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (FF.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
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PARKING
LOT AREA
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PLANNING REVIEWED BY D)Ej
REQ'I._I= I
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REMARKS
CHECKED BY I TYPE OF
CODE I OCCUPANT
SPECIAL INSPECTION-r OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REQ'D ra
Al f I In
AR
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
state Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # rwe, V
APPLICATION APPROVAL
Thisapplication is not a permit until signed by the
Building olficial or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
9F�91_17� IGNA1Ue, DATE
RELEASED �Y
A17EWION ItAl 1;jjj
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/lBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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YELLOW - INSP( :CTOd
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
FiQq,� ................
Wall ............ 6 .........
Pier/Porch .................
Z'
Retaining Wall ...........
0
0
Slab Insulation ..........
M
PLUMBING:
Underground .............
3:
M
C
Rough -in ...................
M 0
0
Commercial Final ......
0 C:
—4 K
HEATING:
3: M
M Z
Gas Test ....................
C _Z
Gas Piping .................
Equipment .................
0 -n
-n
Commercial Final .......
M M
EXTERIOR SHEATHING
0-0)
NAILING ..........................
0
0 M
FRAMING ........................
C (0
C/)
FIRST FLOOR FRAMING ...
Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
cyy
0)
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SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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