20040951A.pdfI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OFfUSINESS
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MAILING ADDRESS
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NAME
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NAME
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ZIP TELEPHONE
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JOB
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Permit Required
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Street use Permit Hoq'd
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EXISTING - PROPOSED
InSDOCtion Required
Sidewalk Required
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REQUIRED DEDICATION- FT
underground
wiring required
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METER SIZE
NE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES E3 NO
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REMARKS
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE PfJKIKED MN
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PROPERTY TAX
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COUNT ARCEL NO.
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ENGINEERING REVIEWED BY DATE
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRON� SIDE REAR FROqT URaDE �IEAR/
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W NUMBER NUMBER OF CRITIC SPECIAL INSPECTION JAREA OCCUPANI
a OF DWELLING AREAS 7e
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC JOB/ IBC109/IRC109 FINAL INSPECTION REO'D
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T2 VALUATION
$ F_
Description FEE Description FEE
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Plan Check State Surcharge
HEAkZURCE Gj% LOT SLOPE %
Building Permi City Surcharge
.CK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
LU
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
U) SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review PlanChk.Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF L__ ILI'
M 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 LandscapeInsp. Total Amt. Due Oct C51)
TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED IL
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION., t# �j ;7
Recording Fee Receipt #
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 This application is not a permit until signe I by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Building Official or his/tier Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LAPOTrGQDE OF THE STATE OF WASHINGTON RELATING TO ECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATkN INSU�ANCE AND RCW 18.27. FOR INSP 'qFFI_qALS SIG ATURE
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SIGNr DATE SIGNED (425) Kk�� - q_
771-0220 'R&ASED BY DATE
ATTENTION V D"Iir%lKir-lr')DQTPHr.TUREUNTILAFINAL Bff 1333 f A ��;[
ITIS UNLAWFUL 10 UbLun UUur A I I
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL -,FILE -) YELLOW- INSPECfOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWN GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES ./I
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LOT SIZE: 20,908. SQ Fr,
LOT COVERAGE:
EXISTING HOUSE GARAGE: 2246 SQ. FT.
NEW DECK:
642.5 SQ. Fr.
TOTAL: 2888.5 SQ. Fr.
13.8%
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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 ..................
The 11litials MT are WWI' I
Thoilli)son, a telliporary contrac
inspector for tile City.
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