20040878.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWqE AME/NAME OF BUSINESS
V/
MAILING ADDRESS
�2171&`7
CITY ZIP TELEPHONE
7 4? 7 76'
NAME
ADDRESS
CITY ZIP ITELEPHONE
NAME ICBL #
CITY ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL PLUMBING/ MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL E] MULTIFAMILY SIGN
[:] GRADING FENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS P
rL ,,EIJINCTIVITY) EXPLAIN:
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NUMBER
0
NUMBER OF
CRITICAL
111
OF
DWELLING
AREAS
0 STORIES
UNITS
NUMBE R
DESCRIBE WORK TO BE DONE
I I I PERMITEXPIRES
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USE PERMIT
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N U M B E 7
JOB suiTE/APT#
ADDRESS 74 A�&F
__2'7 410
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
7EMSC77pp�rovO�
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW po;mit Required
Street Use permit Roq'd
EXISTING - PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT -
Underground
Wiring required
METER SIZE
I LINE SIZE
I NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
GAS PIPE TES MUST BE
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OBSERVED BY CITY INSPECTOR
I AFFIDAVITS SHALL W1
I ENGINEERING REVIEWED BY bc A111tir-P] PH DATE
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FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOT AREA P ED BY DATE
LANNING REVIEW
REO'D I PROVIDED -7�
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oil 1MC 803.2
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CHECKED BY
SPECIAL INSPECTIC
REQUIRED [:] YES
OCCUPA
GROUP 2�,
OCCUPANT
LOAD
1 REMARKS 0
PROGRESS INSPECTIONS PER UBC 108 1 IBC1 09 / IRC1 09 FINAL INSPECTION REO'D I '�
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rVA"LUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % I Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing 44, Base F e
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
W
IL PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Cn '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
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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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
in Landscapeinsp. Total Amt. Due
_j 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. -
Recording Fee Receipt #
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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 APPLICATION APPROVAL
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 AND RCW 18.27. rF1 AILS SIC44A RE
DATE,
DATE SIGNED (425)
wGtqKT%i1REQ04 NT)
OR AGE
0 RELEASED BY
771-022
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU- ORIGINAL - FILE YELLOW INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNEII 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 T6�t ...... * ................
Gas Piping
Equipment.................
Commercial Final .......
EXTERIOR SHEk..!114G
NAILING ..........................
FRAMING ....... ................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
7 Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL NO&
0�1111� ...............
0 0 7.0 voeo
The initials wr are Milton
Thompson, a temporary contract
inspector fbr the City.
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