20040916.pdfa
I
DATE RECEIVED I I
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY Z P TE�EPHONE
G
NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME
o
Ke
ADDRESS
J
CITY zl� TELEPHONE
Lu o I aj�c T �7 1�1 ej L-
STATE LICENSE NUMBER EXPIRATION DATE Wel:
T,
PROPERTY TAX ACCOUNT PARCEL NO
2`�
6
NEW
El RESIDENTIAL
PLUMBING / MECH
ADDITION
E2/cOMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
FENCE
( — X�FT
GRADING
CYD
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
E]
FIRE SPRINKLER
FIRE ALARM
(TYPE OF BUSINESS OR ACTIVITY) EXPLAIN'.
Lu NUMBER' NUMBER OF
DWELLING
OF I
L� UNITS
0 STORIES I
DESCRIBE WORK TO BE DONE
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
_0
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
PERMITEXPIRES
USE PERMIT
ZONE
—oql
NUMBER
JOB
ADDRESS
w4 TA
SUITE/APT#
PLAT NAME/SUBDIVISION NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
RW Permit Required E3
street Use Permit Roq'd C3
EXISTING — PROPOSED
inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION. FT
Underground
Wiringroquitod C3
METER SIZE _[L"ZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO E3
Z
cc
tu
REMARKS
z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
a
z
ENGINEERING REVIEemrrirl� -SPECTMI
, V IN ,
QzS;n\11tTj �'i - - �
D BY
REVIEWE ' S ) 'DATE us
AFFIDATI cc
I Ij M
Rf. AURTE13
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
SEPA REVIEW SIGN AREA OYES ONO S HEIGHT —
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED PROPOSED
EXP I I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
z
-2
z
__TLOT AREA I PLANNING REVIEWED BY I 1L
PARKING DATE
REO'D I PROVIDED
REMARKS
CHECKED BY
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPA1,11
REQUIRED 0 YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/18CI09/IRC109 FINALINSPECTION REQ'D , -
VALUATION
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
SEPARATE PERMISSION.
cc
LU
PERMIT APPLICATION: 180 DAYS
9L
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
!I
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2
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 THIS PERMIT SHALL NOT BE
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.,
Mi
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 �'�DE OF THE STATE OF WASIiINGTON RELATING TO
WORKMEN'S COMPENSATI911XSUI)ANCE AND RCW 18.27.
, f
SIGNATURE 11AIERIOR N
DATE SIG)NED
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
I-L-)
Plumbing
Base Fee
12
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt
2,q
APPLICATION APPROVAL
CALL
This application is not a permit until signed by the
Building ofiicial or his/her Deputy: and Fees are paid. and
FOR INSPECTION
receipt is acknowledged in space provided.
OFFICIALS, SIGNATURg DA
N
(425)
L 1
771-0220
ED BY �ATE/
A17ENTION I E)ff 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
z
0
i
0
M
--I -n
M
M
0
10
0 C:
M
M z
1[) -4
C
3:
0 -n
n
M M
0
0
0 M
C: cl)
F, Cn
M C.)
Z
3:
z
—4
X
W
z
0
1
0
M
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION -
Footing ......................
Wall ........
Pier/Porch .................
Retaihing,Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
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 ..................
L A-
z
0
A
0
M
--I -n
3:
0 M
M 0
0
0
0
M
M z
_Z
o -n
M M
0
0
0 M
C cl)
9 Cn
M 0
Z
z
z
0
M