20040956.pdf6
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DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS ir
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MAILING ADDRESS
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CITY ZIP
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NAME
CITY
NAME
ADDRESS
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CITY
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ZIP TELEPHONE CBIL
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ZIP TELEPHONE
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STATE LICENSE NUMbER EXPIRATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
1:1 RESIDENTIAL
ADDITION
10 COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
El GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
%� C (-_ R A � I:-
HEAT SOURCE
GLAZING %
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PLUMBING / MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
( X FT)
El
OTHER
FIRE SPRINKLER
1 :1
FIRE ALARM
CRITICAL
AREAS
NUMBER
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LOT SLOPE %
PLAN CHECK NO'0Lj VESTED DATE
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. I 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 DIRECTtY 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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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 COMPENSATI U NCE AND RCW 18.27.
DATE SIGNED
SIGNAT E (OWNER -OR —F, kii I -� to LI
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[PERMIT EXPIRES
USE PERMIT
ZONE C/1
NUMBER czAs
JOB SUITE/APT#
SUJ
ADDRESS
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PLAT NAME/St DIVISION NO. LOT NO, LID NO.
LID FEE $
TESCP Approved
PUBLIC IflGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Required
Street Use Pennit Raq�d
EXISTING — PROPOSED inspection Required
Sidewalk Required
underground
Rf,,UIIIED DEDICATION— FT Winng required
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
I YES 13 NO 1:1
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I X_
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ�D I PROVIDED
REMARKS
CHECKED BY ITYPE
SHORELINE OR ADB# I INSPECTION BOND
REO'D POSTED
OYES KO s
HEIGHT
ALLQ� )SED I ALLOWED - PROPOSED
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR
FRONT
L/R SIDE REAR
LOT AREA I
P INNING REVIEWEP By
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DATE
11/1,5/6rii
SPECIAL INSPECTION JAREA
REQUIRED F] YES
CODE OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS I LEI
PROGRESS INSPECTIONS PER LIBC 108 / IBC1 09 1 IRCII 09 FINAL INSPECTION REO'D 5
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
i its app, cat on s not a permit until s gned by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in spac) provided.
OFFICIALS SIGNATURE TE
(425)
771-0220 REfifASf D EfY DATE
V-y /
All I IZNJIIU14 QA 1 10%3%3
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL —41
INSPECTION HAS BEEN MADE AND APPROVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
VALUATION
$ �SC)6 00
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL' -FILE YELLOW -INSPECTOR
PINK -OWNER 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:
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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