20040946.pdfDATE RECEIVED tj PERMIT EXPIRES
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I USE PERMIT
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CITY OF EDMONDS NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/NAME OF BUSINESS �2
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MU MAILING ADDRESS,. LID FEE $
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3. PUBLIC RIGHT OF WAY PER OFFICIAL STREE RW Permit Required
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CITY zip I TELEPHONE EXISTING - PROPOSED inspection nequired 13
Sidewalk Required E3
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REQUIRED DEDICAIION_ FT Winng required
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 1:1 NO 13 z
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3: OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 6
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.7 VARIANCE OR CU SHORELINE OR AOB# INSPECTION BOND
NUMBER r-1 -6 'IV EXPIRATrN ATE rY REO'D POSTED
OYES ONO S
SIGN AREA HEIGHT
ALLOWED PROPOSED
SEPA REVIEW
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
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NEW 0"'RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT IJR SIDE REAR
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UNITS NUMBER REQUIRED []
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DESCRIBE WORK TO BE DONE
REMARKS 9
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
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VAL ON
Description FEE Description FEE
plan Check State Surcharge
HEAT �OUF17E GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO:
VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180DAYS
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KL PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 1130 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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!j 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 OFWHATEVER NATURE. ARISING DIRECTIYOR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
x 0 NOR LIMIT IN ANY WAY THE C"'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I - Recording Fee Receipt #
1 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 Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED PECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELAI ING TO FOR INS DATE
WORKMEN'S COMPENSA��URANCE AND RCW IB.27. OF IAt,S SIG ATURE
SIG ATURE (OWNER 0) AGENT) ED (425)
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j DATE SIGN
771-0220 RELEASED B X)ATEI
'TT'T'E N T 10 N EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04j02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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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:
....................
GasTes t
Gas Piping .................
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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 ..................
nic Initials MT are Milton
Thollipson, a temporary contract
illspector for the City.
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