20040900.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF 13USINESS
42:� 4r
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
NAME
ZIP I TELEPHONE
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ADDRESS
C I T.Y,
ZIP
TELEPHONE
STATE LICENSE NUMBER
EXPIRATION DATEQHEC
BY
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
I;D,,-hESIDENTIAL
OS-1 UMBING / MECH
ADDITION
//�D COMMERCIAL
COMPLIANCE OR
El CHANGE OF USE
,;"-IEMODEL
MULTIFAMILY
11 SIGN
REPAIR
GRADING Ei FENCE
CYDS ( X FT)
E] DEMOLISH
TANK
OTHER
1:1
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
1:3 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: rRI—,
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
I
AREAS
/U//+
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
-70�
I,-) -
t.
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I 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 (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I 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 T HIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYs ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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 I-AWS REGULATING CONSTRUC-
TION; AND IN DOING THE WOPK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THR LAI39R�ODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPFASATIC)N'INSI)PANCE AND,RCW 18.27.
I PERMIT EXPIRES
.� /0
OSE PERMIT
ZONE NUMBER
JOB SUITEJAPF#
ADDRESS q71/1
, /�) 7
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
TESCP AP
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required
Street use Permit Req'd E3
EXISTING - PROPOSED inspection Required 13
Sidewalk Required C1
Underground
REQUIRED DEDICATION- FT Winng required 13
METER SIZE LINE SIZE NO 01 FIXTURES PRV REQUIRED
YES13 NO 13
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REMARKS z
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
Z
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REDO POSTED
SEPA REVIEW SIGN AREA OYES ONO I S HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS JFT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
PC B �r L ven connectors required
REMAIMi fuel -burning appliances passing
— throu2h unheated spoope. _MC 303.2
CHECKEDBY JTYPEfyj�MTON OCCUPANT
GRO UP
SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D 9
VALUATION
Description
FEE
Description
FEE
Plan Cherk
State Surcharge
Building Permit
City Sur harge
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Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTIr
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
/_i;pcturiti cknowledgedin space provided.
OF I AL SIIGNATU DAII E
S170URE �W�E DATE SIGNEf
bl�
771-0220 F! If ASED
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - 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 ....................
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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