20040951.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS I/
a: MAILING ADDRESS
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NAME
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ZIP TELEPHONE
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PERMIT EXPIRES it
UhE PERMIT
ZONE NUMBER
JOB -7 SUITE/APT#
ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
0 %%Ott '00i LID FEE $
TESCP APPMwol
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW p0,Md Roqu,fod
Street Use permit Roq'd
EXISTING � PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT Underground
waing required E
P P RV REQUIRED
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METER SIZE NO. OF FIXTURES
h YES 3 NO
NAME
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ADDRESS
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STATE LICENSE NUMBER
EXPIRATION DATE
CHECKEE�B�
PROPERTY TAX ACCOUNT PARCEL NO.
5 bl� 1Lf "S 000 n
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NEW
RESIDENTIAL
10
PLUMBING if MECH
ADDITION
COMMERCIAL
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1:1
COMPLIANCE OR
CHANGE OF USE
El REMODEL
MULTIFAMILY
1:1
SIGN
REPAIR
GRADING
CYOS
1:1
FENCE
( X FT)
DEMOLISH
TANK
1:1
OTHER
GARAGE
CARPORT
RETAININGWALL
ROCKERY
1:1
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS
OR ACTIV" EXPLAIN:
5V
P A&Y�
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I x.—
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
I
IiIIII-4
DATE
SHORELINE ORADIII I INSPECTION
REaD
DYES XNO
GN AREA
FA L L 0 WSED PROPOSED I ALLOWED
BOND
POSTED
IGHT
PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA I PrNING
4JI4_
CHECKED BY [TYPE OF
DATE
I A 'CIA,
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT,/
REQUIRED [:] YE I LOAD I
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REMARKS 1(35
PROGRESS INSPEC71ONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REQ'D a
VALUATION
$ L_
11 50
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: 180DAYS
PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT. 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
FROM THE ISSUANCE OF THIS PERMIT ' ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
x 0 NOR LIMIT IN ANY WAY THE ci rrS ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt #
GIVEN IS CORRECT., AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATI�ONAPP OVAIL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- f his application is n t a Permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building 011icial or histh , Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO receipt is ackno
YfR'S!�NCE AND RCW 10.27.
WORKMEN'S COMPENSATIO FOR INSPECTION lodged in space provided.
OFFICIALS SIGNATURE
'14t I � I �T[
SIGNATURE (OWNER OR E Lr) DATE SIGNED ('425) irn %.,
771-0220 RELE F1 � Y
AltItNTION E)ff 1333 DATE
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE
PANCY HAS BEEN GRANTED. UBC109/IBC110/1RC110. PINK - OWNER '.YELLOW. I SPECTOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES 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 ..................
95/ &000'
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