20040967.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAM E/SU BDIVI SION NO
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
LOT NO.
LdPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE [ NO. OF FIXTURES
LID NO.
LID FEE $
TESCP Approved
13
AW Permit Required
13
Street Use Permit Roq'd
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Inspection Required
13
Sidewalk Required
13
Underground
Wiring required
13
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NAME CEIL #
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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CITY TELEPHONE
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VARIANCE OR CU SHORELINE OR ADBI1 INSPECTION BOND
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STATE LICENSE NUMBER EXPIRATION DATIE CHECKED BY
REO'D POSTED
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SIGN AREA HEIGHT
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SEPA REVIEW
EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
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EXP , I ,
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NEW RESIDENTIAL PLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
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PARKING LOT AREA PLANNING REVIEWED BY DATE
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REMODEL MULTIFAMILY SIGN
REQ'D I PROVIDED
GRADING FENCE
0 REPAIR CYDS ( — X —FT)
REMARKS
DEMOLISH TANK E] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
FIRE ALARM
CARPORT ROCKERY
ITYPE OF USE B SINESS OR ACTIVITY) EXPAAIN:
CHECKED BY TYPE OF CONSTRUCTION CODE OCCUPAt`5
�2 GROUV-S
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
I NUMBER
TI OCCUPANT
SPECIAL INSPECTION AREA LOAD
REQUIRED
STORIES UNITS
YES
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/lRC109 FINAL INSPEC11ON REQ'D
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VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
HE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMITl YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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!I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
a NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, THE DULY AUTHORIZED AGENT OF
THEANDIR IAG E To COMPLY WI CITY AND TATE LAWS REGULATING CONSTRUC-
TIO I� DO'ff THE WORK AUTH IZED THI EBY. NO PERSON WILL BE EMPLOYED
IN AOLAXION QF T\IE LABO CO E F THE S ATE OF WASHINGTON RELATING TO
'OR C
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E AND R W IB/27.
WOtMEI�S C+PE�SATION IINSL C W
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SIGN ER EN
DIE
SIGNED
/ALUATION
Descriptioqn
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D escription
FEE
31an Check
TEE
State Surcharge
3uilding Per mit
City Surcharge
31umbing
Base Fee
Mechanical
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Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(42Ei) /
771-0220 "FRIELEASEQ-V
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
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U�n
DATE
ATTE�ItIITION TURE UNTILAFINAL
IISU FULTO USE OR OCCUPYABUILDING OR STRUC
T�W
ECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK -OWNER GOLD -ASSESSOR
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 (Y)s
OCCUPANCY ..................
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