20040930 (2).pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
USE
ZONE
Jon
ADDRESS
PERMIT EXPIRES
PERMIT
N U M B E R
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PLAT NAMEISUBDIVISION NO, LOT NO.
LID NO,
LID FEE $
JESCF Approved
13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
Street Use Permit Roq'd
0
EXISTING - PROPOSED
inspection Requited
Q
Sidewalk Required
[3
REQUIRED DEDICATION- IFT
Undargrotind
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 1:1
REMARKS
OWNER/CONiRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
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NAME
ZQAI
CBL#
ENGINEERING REVIEWED BY DATE
Ad`�RESS
FIRE REVIEWED BY DATE
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CITY ZIP
TELEPHONE
VARIANCE OR CU
SHORELINE OR ADBII I
I
INSPECTION
REO'D
OYES ONO
BOND
POSTED
IS
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
SEPA REVIEW
COMPLETE I EXEMPT
EXP
SIGN AREA
ALLOWED , PROPOSED
HEIGHT pc)qFn
ALLOWED , PRO
PROPERTY TAX ACCOUNT PARCEL NO.
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NEW FZKRESIDENTIAL PLUMBING / MECH
COMPLIANCE OR
OADDITION COMMERCIAL CHANGE OF USE
I�EMODEL MULTIFAMILY El SIGN
REPAIR GRADING FENCE
CYDS X FT)
OTHER
DEMOLISH TANK El
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/R SIDE REAR
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PARKING
REO'D I PROVIDED
LOT AREIPLANNING
REVIEWED BY DATE
REMARKS
(TYPE OF USE, BUSINESS O2,4GTIVI E LAIN:
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CHECKED BY
TYPE OF U T)IN
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OCCUPANT
GROUP
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NUM13ER
STORW—%
NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS.
I NU MBE
SPECIAL 11 4SPECTION
REQUIRED YES
JAREA
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 1081IBC1109 / IRC109 FINAL INSPECTION REQ'D
M
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit_
City Surcharge
PLAN CHECK NO: VESTED DATE
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT I 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
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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Total Amt. Due
0 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."
Fee
Receipt 4
Recording
I 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
THE OWNER. I AGHLE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
Building Official or his/tier Deputy: and Fees are paid, and
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.
0 FI A�.,S SIGNAf1UP E OAT
IGNATURS-�w OR AGE DATE SIGNED
S GNATUR��- 11 OR AGE:
(425)
771-0220
-'tELfAS50 8Y �ILIATV
AXTENTION
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IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCIJ-
ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/lBC110/IRC110.
PINK - OWNER - GOLD - ASSESSOR
`19/03 PRESS HARD -YOU ARE
MAKING 4 COPIES
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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
YV).%
OCCUPANCY ..................
030
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