20040924.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
UWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED BY
'ROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL (P7LM�91�N��
ADDITION
COMMERCIAL
COMPLIANCE OR
El CHANGE OF USE
REMODEL
E] MULTIFAMILY
E] SIGN
REPAIR
GRADING
1:1 CYDS
m FENCE
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El
DEMOLISH
E] TANK
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oil
oGARAGE
RETAINING WALL
E]
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
(TYPE OF USE. BUSINESS
OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL 3-7iniq
OF
DWELLING
AREAS
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STORIES
UNITS
NUMBFX57n-1-�1
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NIP:_. I VESTED DATE
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.
UJI PERMIT APPLICATION: 180 DAYS
QL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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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
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
_jp�VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSADON INSURANCE AND RCW 18.27.
SIGNaATU(OWNER 0 TGENT)"_1 DATE SIGNED
03
,,i� ZI I I PERMIT EXPIRES
USE PERMIT
ZONE 17 41n1l,
NUMBER
JOB
ADDRESS/
PLAT NAME/SUBDIVISION No.
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION�
FT
METER SIZE I
LINE SIZE
I NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
TIESCP Approved
F3
AW Permit Required
E3
Street Use Permit Roq'd
E3
Inspection Requited
E3
Sidewalk Required
13
Underground
Wiring required
1:1
PRV REQUIRED
YES 13 NO 13
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP
DATE
DATE
SHORELINE OR ADBI1 I INSPECTION BOND
FlEa
&, POSTED
ES )RNO s
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
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LOT COVER REQUIRED SETBACKS (FT) P �SED SETBACKS (FT.)
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ALLOWED PROPOSED FRONT SIDE REAR a
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PARKING P6 a.
REQ'D PROVIDED LOT AREA )NING R EWE Y DA7
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REMARKS
CHECKED BY I TYPP CUE OCCUPANT
,�F.,ONSTRUCTION
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SPECIAL INSPECTION JAREA' OCCUPANT
REQUIRED C: LOAD
REMARKS 0
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PROGRESS INSPEC11ONS PER UBC 108/IBC1W/lRC109 FINAL INSPECTION REO'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-022V
EXT 1333
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FIFICIALS SIGNrA7F/ DA E
?J'ASED BYr, I 4DA T E
ITIS UNLAWFULTOUSE OROCCUPYABUILDING OR STRUCTURE UNTILAFINAL U/ �4 =-/- _ 44z,
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU- C. - of
RIGINAL - FILE
PANCY HAS BEEN GRANTED. UBC109/iBC110/[RC110. PINK - OWNER
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
YELLOW - INPECX
GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch .................
0
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING:
0
M
c::
Underground .............
M
0
—10
Rough -in ...................
0 C:.
Commercial Final ......
?.
M
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HEATING:
C z
>
Gas Test ....................
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Gas Piping .................
0 -n
_n
Equipment .................
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Commercial Final .......
M M
0 W
EXTERIOR SHEATHING
0 r-
0 M
NAILING ..........................
C/)
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FRAMING ........................
Q 0
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FIRST FLOOR FRAMING
...
INSULATION ...................
>
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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0
SHEETROCK NAILING ...
0
IT!
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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