20040949.pdfa
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CITY OF EDMONDS ZONE
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CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
PERMIT EXPIRE
PERMIT
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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LID FEE S
PUBLIC RIGHI OF WAY PER OFFICIAL STREET MAP
I ESCP AP proved E3
FjW Permit Required 13
Street Use Permit Roq'd 13
EXISTING - PROPOSED
inspection Required 13
Sidewalk Required 13
REQUIRED DEDICATION-
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Underground E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
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PRV REQUIRED
YES 0 NO 13
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OWN E RICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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ENGINEERING REVIEWED BY
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FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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SEPA REVIEW SIGN AREA I OYES ']NO $ HEIG11T
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
1110ifn MOnDnCED SETBACKS IFM
LOT COVERAGE nl�w �Q � y
NEW RESIDENTIAL PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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COMPLIANCE OR F
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL
MULTIFAMILY
SIGN REO'D
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REPAIR
FENCE
( X Fr) REMARKS
GRADING
E] CYDS
DEMOLISH
TANK
OTHER
EiGARAGE
CARPO
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSWESQ� OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS I NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE
PLAN CHECK NO:
GLAZING %
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LOT SLOPE %
VESTED DATE
CHECKED BY
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OCCUPANT
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SPECIAL INSPECTll6N , ARE"e
OCCUPANT
REQUIRED C] YES
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LOAD
REMARKS
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INSPECTIONS PER UBC
108/ IBC1091 IRC109 FINAL INSPECTION REQ'D . �
VALUATION
Description
Plan Check
Building Permit
Plumbing
FEE Description
State Surcharge
City Surcharge
I Base Fee
FEE
A JLT I 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
J SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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 Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON, IfS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt it
ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE LandscapeInsp. Total Amt. Due
9 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. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND T14AT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
ING CONSTRUC- this application is not a perinit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULAT CALL Building Official or lits/her Deputy! and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION _ RELATING TO FOR INSPECTION receipt is acknowledged in space provided
pj�.JHE LABOR CODE OF THE STATE OF WASHINGTON
WORKMEN. 5�6m"SATION INSURANCE AND RCW 10 27. DITE
OFFICIAI S SIGNA1 URE
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SIGNATUFf (OWNER R At, DATE SIGNED (425) A A
D4E
771-0220 RF I FASFD BY
ATTENTION EXT 1333
ITISUNLAWFULT USEOROCCUPYABU DING OR STRUCTURE UNTILAFINAL
INSPECTION HASBEEN MADE AND APP/(01VALOR A CERTIFICATE OF OCCU- OR(GINAL F;1� YELLOW - INSPECTOR
'SESSOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK GOLD -AS
09/03 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:
Gas Test ....................
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 ..................
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