20040876.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
CITY ZIP TELEPHONE
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13 FIRE ALARM
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PERMIT EXPIRES
USE PERMIT
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SUITE/APT#
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PLAT NAMEISUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
TESCP Approved
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PUBLIC RIGHT OF WAY PER OFFICIAL
STREET MAP
RW Permit Heqw(od
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Street Use Permit RGq'd
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EXISTING - PROPOSED.
inspection Required
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Sidewalk Required
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REQUIRED DEDICATION-
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Wiring roquirua
METER SIZE
LINE SIZE
NO. OF FIX`TURES_FV
PR REQUIRED
ES 13 NO 13
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/D RAIN AGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
HORELINE OR ADBO I INSPECTION
BOND
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SIGN AREA
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ALLOWED PROPOSED
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FrT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
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PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
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CHECKED BY ITYPE OF CONSTRUCTION CODE OCCUPANT
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REQUIRED [:] YESr LOAD
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PROGRESS INSPECTIONS PER UBC 108/ IBC109 / IRC109 FINAL INSPECTION REO'D i
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
61<_ I
PLAN CHEIC121110,.: VESTED DATE Plumbing Base Fee
Mechanical -72�
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR L40RE INFORMATION
'APPLICANT, ON BEHALF OF HIS 08 HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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 1 HIS PERMIT SHALL NOT 13E
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total . Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION"
Recording Fee Receipt #
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- CALL This application is not a permit until signed by the
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 COMPENSATION INSURANCE AN[)-ft
11 � OFFICIALS SIGNATURE RATE
SI;GVNATU ER MT DATE S;IGNZE (425)
7 -0220 BY DAf E
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ATTEN-rION Off 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSPECT/on
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
PROVED
INSPECTOR DATE AP
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING,
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
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Gas Test ....................
Gas Piping ................. C)
Equipment .................
Commercial Final .......
EXTER108 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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