20040955 (2).pdft___
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
CITY
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NAME
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NAME
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11111-.111
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STATE LICENSE NUMBE�h EXPIRATION DATE I/CH
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PROPERTY TAX ACCOUNT PARCEL NO.
040 6 14_�
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAK.
T'� k I C I �1 I r
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9 k
12
PLUMBING/ MECH
11
COMPLIANCE OR
CHANGE OF USE
[:1
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
U�E PERMIT
ZONE
NUMBER
JOB -I �4 x I - -�\� I
SUITE/APT#
ADDRESS
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PLAT NAMEISUBDIVISION NO.
LOT NO,
LID NO.
PP k/ 4 P I f' 1
1 �7
LID FEE $
�0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appmod
RW Permit RoQtjlfOd
[3
Street use Permit Roq'd
[3
EXISTING - PROPOSED
Inspection Required
E3
Sidewalk Required
E3
REQUIRED DEDICATION-
FT
Underground
Wiring required
[3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I X
LOT COVERAGE
ALLOWED PROPOSED
0
PARKING
REQ'D I PROVIDED
REMARKS
BY
DATE
DATE
SHORELINE OR ADB# INSPECTION PBOND
a OSTE D
DYES NO S --
SIGN AREA HEIGHT
[ALLOWED -PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
LOT AREA
ipc
CHECKED BY I TYPE OF
fii NUMBER NUMBER OF CRITICAL I
OF DWELLING AREAS SPECIAL INSPECTION AREA
o STORIES UNI LA NUMBER REQUIRED !S
DESCRIBE WORK TO BE DONE I
DATE
I I /I
OCCUPANT
GROUP
LOAD
REMARKS
PROGRESS INSPEC71ONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
uj 11- 14 1 + e.-wr- P u AAP,
VALUATION
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escription
Plan Check
HEAT SOURCE
GLAZING %
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LOT SLOPE %
Building Permit
PLAN CHECK NO-
;0t) _5/ L4
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFX 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 OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OFTHIS PERMIT SHALL NOT BE
DEEMED TO MODIF'4 WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMI T IN ANY WAY THE CITY'S ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION."
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I 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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENS2�=RANCE AND RCW 18.27.
CALL
FOR INSPECTION
(425)
771-0220
SIGNATURE (OWNER CLIq EN
- X L-1 - - _-IIIIIIIIIIIIIIIIIIIIIIIIIIIII
DATE SIGNED
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ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEANDAPPROVAL OR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in spa 0 provided.
OFFICIALS SIGNATURE TE
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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
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OCCUPANCY ..................
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