20040899.pdfI
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF: BUSINESS
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MAILING ADDRESS
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CITY ZIP ELEPHOINfE
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NAME
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STATE LICENSE NUMBER
EXPIRATIrON DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLIANCE OR
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IVESTED 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: 180 DAYS
PERMIT LIMIT: 1 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 O�
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING OIFIECTLYOR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CI ry ORDINANCE
NORLIMITINANYWAY THE CII Y'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.
I HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT Or
THEOWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATINC, CONSTRUC
rION. AND IN DOING THE WORK AUTHORIZED THEIJEBY. NO PERSON WILt 131: EMPLOYEE)
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGION RELATING 10
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27
SIGNATUR,, DA1 FSIGNED
PERMIT EXPIRES
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U�E PERMIT
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NUMBER
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PLAT NAME/SUBDIVISION NO COT NO, f LID NO.
PUBLIC RIGHT OF WAY PER OFFICIAL ST PEE T MAP
EXISTING - PROPOSED
LID FEE S
TESCP Approved
RW permit Required
Street Use Permit Req d
Inspeclion Required
Side alk Re Lured
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Underground
REQUIRED DEDICATION— FT Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I Y"�--_
LOI COVERAGE
ALLOWED PROPOSED
REVIEWED/DATE
SHORELINE OR ADB#
SIGN AREA
ALLOWED . PROPOSED
DAT E
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INSPECTION I BOND
REO'D . POSTED
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HEIGHT
ALLOWED . PROPOSED
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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CHECKEDBY IT] N COE OCCUPANT
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SPECIAL INSPECTOR AREA OCCUPANT
REQUIRED E] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'L) c)
a)
�ATT�NTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERETIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
5:98
VALUATION
PE. AN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING f;V L
ENG REVIEW FEES
ENG INSPECTION FEE
LANDSCAPING
INSPECTION FFE
RECEIPT
PLAN CHECK DEPOSIT
FEE
TOTAL AMOUNT DUE
CEIPT
M_--n-
APPLICATION APPROVAL
CALL
I ills j1pplicition is not d permit until signod by Mt. -
Buildinj 0111cia! or hisiher Deputy ind Poes irL vaid dml
FOR INSPECTION
recoll)l isacknowlodged in space proviclea
(425)
OFFICIALS SIGNATURE DAT E
771-0220
RELEASED BY DA
EXT 333
771-0221
ORIGINAL - L E YE OW - INEkECT06
FAX
"R G LD - ASSESSOR
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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 .................... ell 12'd)
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Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
Me,
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR d -7
OCCUPANCY ..................
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