20040952.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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STATE LICENSE NUI�BER
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PROPERTY TAX ACCOUNT PARCEL NO.
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El NEW
RESIDENTIAL
El ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
o RETAINING WALL
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[TYPE OF USE, BUSINESS
OR ACTIVITY) EXPLAIN:
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NUMBER
NUM13ER OF
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STORIES
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HEAT SOURCE
PLAN CHECK NO
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110-
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PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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LOT SLOPE %
VESTED DATE
F711
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 08 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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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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 WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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TTION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN VIOLATION OF THE LABQFr6QDE OF THE STATE OF WASHINGTON RELATING TO
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WORKMEN'S CCMPENSAT#T1NSL�ANCE AND RCW 18.27.
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SIGNATURE (OWNER V GE'N DATE SIGNED
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITEIAPT#
ADDRESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
7ESCP Approved
AW Permit Requited
Street Use Permit Roq'd
EXISTING - PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION-
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Underground
I Winne required
METER SIZE
LINE SIZE
NO. OF FIXTURES
I PRV REQUIRED
YES 1:1 NO 13
REMARKS
OWNERICONTRAcrOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR A111111 I INSPECTION I BOND
REqP POSTED
DYES ]%NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP —4—
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOT AREA PMING REV EWE[] B , F DATE
REQ'��OVIDED I I l- 6"1 / ji It
REMARKS If/
CHECKED BY ITYPE OFPZA!M In OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REOUIREDE] N LOAD
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REMARKS 0
PROGRESS INSPECTIONS PER USC 108/IBC109/IRCID9 FINAL INSPECTION REOTI K
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Lin
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt
Landscapelnsp.
Total Amt. Due
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Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVA L
This application is not a permit until signed by the
Building official or hisihot Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE D E
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1
HE DATE
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL NK
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- jkk4L_
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC 109 / IBC1 10 / IRC1 10. PINK - OWNER * GOLD - ASSESSOR
09/03 1
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 ........... z
0
I
Slab Insulation ..........
0
M
PLUMBING:
Underground .............
Rough -in ................... 0 M
C
171
Commercial Final ...... 0
0 C:
HEATING:
M
ITIZ
Gas Test .................... JO --1
C z
Gas Piping ................. >
Equipment ................. M-S
0 -n
Commercial Final .......
EXTERIOR SHEATHING
M M
NAILING ..........................
0
FRAMING ........................ 0 rn
C Cn
FIRST FLOOR FRAMING ...
111 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... >
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Ceiling Insulation .......
SHEETROCK NAILING ...
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0
SPECIAL INSPECTION
0
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MISCELLANEOUS .......... i
FINAL APPROVAL FOR
-D5
OCCUPANCY ..................