20040932.pdfU
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
MAILING ADDRESS
CITY
NAME
I CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
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'ROPERTY TAX ACCOUN
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ZIP ONE
ZIP I TELEPHONE
ZIP I TELEPHONE
PARCEL NO.
CBL
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CHECKED BY
NEW
ff�RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
Q_��MODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
Ei
FENCE
( X FT,
DEMOLISH
M TANK
El
OTHER
GARAGE
RETAINING WALL
1:3
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE. BU OR APTIATY) EXPLAIN,
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
I
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMEIER.,:�,
SUITE/APT#
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
�EQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
LID NO.
LID FEE $
TIESCP Approved 13
RW Permit Required
Street Use Permit Rold
inspection Required
Sidewalk Roquited 13
Underground
Wiringirecimrad
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Ull
IANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDED
REMARKS
SHORELINEORADBO I INSPECTION BOND
FIF
_ O'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED . PROPOSED - At -OWED PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (IT)
FRONT SIDE REAR FRONT IJR SIDE REAR
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LOT AREA I PLANNING REVIEWED BY DATE
CHECKED BY F ONSTRU TION CQ05,_ OCCUPA�N�T
Y RU
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SPECIAL INSPECTION AREA OCCUPANT
REQUIRED [3 YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/iRCID9 FINAL INSPECTION REQ'D
GAS PIPETE
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MERV Off# 1
VALUATION
1AFFIDAVITIN SHAH Nni
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Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing Base Fee
I-
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.
2
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
* EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
* FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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5 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
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 W1111 CITY AND STATE LAWS REGULATING CONSTRLIC-
CALL
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
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 11127.
SIGN TURE (OWNER 0 A NT). DATE SIGNED
(425)
771-0220
ATTENTION ' XT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC10911IBC110/iRCIIO.
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
ihisapplication is not a permit until signed by the
Building Official or his1her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
C I S) SIG ATURE DATE
�/ ... .... E
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[.EASE[) BY 4)ATE�
09103 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:
6q
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRSf -FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The initialsm I 'If . C Milton
Thompsoll, a milpol.,11-y colltract
UISI)CC(of. fol. tiC City.
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