20040926.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY TELEPHONE
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ZIP
NAME
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NAME
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUNT PARCEL NO
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EXPIRATION DATE C CKI
C)IILI A? 5- Z7$111
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
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REMODEL
MULTIFAMILY
REPAIR
GRADING
CYDS
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DEMOLISH
TANK
GARAGE
El
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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uj NUMBER NUMBER 0
a OF DWELLING
M UNITS
0 STORIES
DESCRIBE WORK TO BE DONE
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AM
HEAT SOURCE GLAZING %
PLAN CHECK NO:
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PLUMBING / MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
X� FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
VESTED DATE
PERMIT EXPIRES
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USE PERMIT
ZONE NUMBER
:L21144, 4�t/
JOB 2 SUITE/APT#
ADDRESS r] �5�r` Ave
PLAT NAMEISUBDIVISION NO. LOT NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCP Approved
HW Permit Required
Street Use Permit Roq'd
EXISTING - PROPOSED
Inspection Required
Siclowelk Required
REQUIRED DEDICATION- FT -
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
SHALL BE INSTALLED ON THE
FIRE REVIEWED By
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PRC
F1
DATE
DATE
SHORELINE OR ADBI I INSPECTION BOND
RE 'D POSTED
OYES 11NO S
T_
SIGN AREA HEIGHT
ALLOWE D , PROPOSED AIIOWED - PROPOSED
Z
M
W
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a
z
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REQUIRED SETBACKS (FT) PROPOSED SESTBACKRSEA(Fr-)
FRONT SIDE REAR FRONT UR BE R
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L8T AREA I PLANNING REVIEWED BY DATE
FSUANrf TO UPC 608
CHECKED BY IT] STR� C N C;�� OCCUPANT
GROUP
SPECIAL INSPECTION AREA OCCUPANT
LOAD
REQUIRED [] YES
REMARKS 1�
PROGRESS INSPECTIONS PER UBC 108 IBC1 09 IRCI 09 FINAL INSPECTION REQ'D 9
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
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 Grading
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
j SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
Lu
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) '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 #
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 Landscape Insp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* Receipt H
Recording Fee
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL s are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fee
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. e URE DATE
fF)ALS SI)GN�T
LT
sl URE (OWNER OR(Z E DATE SIGNED (4 2 5)
L/ 771-0220 4EL 3
A17ENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL I
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/1BC110/lRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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TE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS* .......................
FOUNDATION:
Fdoting ......
Wall ..........................
Pier/Porch .................
z
0
Retaining Wall ........... -4
Slab Insulation .......... ITI
PLUMBING: =i 9
Cl)
Underground ............. 3:
M
C
Rough -In ................... IT! 0
0
Commercial Final ......
0 C
-4
HEATING: 3: M
M Z
GasTest ....................
z
Gas Piping .................
Fn
Equipment ................. 0 -n
n
Commercial Final ....... __4
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0
0 M
FRAMING ........................ C cl)
FIRST FLOOR FRAMING ... Q 0
Z r
.,IN ULATION ...................
;U
--I
F106r Insulation .........
z
Wall Insulation ...........
Ceiling Insulation .......
z
SHEETROCK NAILING ... 0
--I
SPECIAL INSPECTION ... 0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................