20040928.pdfDATE RECEIVED
USE
CITY OF EDMONDS ZONE
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME1NArM4-0E-Wd5R4F6e 1 (7 /
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MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
ADDRESS
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STATE LICENSE NUMBER EXPIRATION I
PROPERTY TAX ACCOUNT PARCEL NO.
NEW 0 RESIDENTIAL
ADDITION I F] COMMERCIAL
1:1 REMODEL
0 MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EGARAGE
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o RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
OF
—
NUMBER OF
DWELLING
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STORIES
UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING
CHECK NO:
73 --,
CBL #
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT
OTHER
FIRE SPRINKLER
FIRE ALARM
I PERMIT EXPIRES
NUMBER
SUITE/APT#
LID NO.
4W� _10A,
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE i NO. OF FIXTURES
LID FEE $
IESCP Approved
FIW Permit Required
Street Use Permit Poq'd
Inspection Rocitniod
c
sidewalk Hequitad
underground
Wiring required
15_�
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY
DATE
UA
1�pe B or L veilt collijectors . require
through WA
-'SEPK'REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
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SIGN AREA
ALLOWED , PROPOSED
ION BOND
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HEIGHT
ALLOWED - PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE IL
REO'D I PROVIDED I
REMARKS
CHECKEDBY ITYPE71
,�r
C2r OCCUPANT
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GROUI
CRITICAL
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIRE[ LOAD
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
5
-1 M
LOT SLOPE %
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 (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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 OF
EDMONDS, WASHING TON, 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 MODIF'� WAIVE OR REDUCE ANY REQUIREMEN1 OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CHYS 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 LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S 50MU,,.NSATION INSURANCE AND RCW 18 27.
I
DATE/'
N A��U E , OWNE ,NED
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
A
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Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771 0220
APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIA S WSI/ I NATLV D TE
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ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE U NTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A 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:
GasTest ....................
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 ..................
I'lle initials MT are Milton
Thompson, a temporary contract
inspector for tile City.
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