20040976.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
Ell REPAIR FIIIII CYOS ( x FT)
OTHER
DEMOLISH TANK
Z Ei GARAGE Ei RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
J�FE OF US E, BUSINESS OR ACTIVITY) EXPLAIN:
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Lu NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
0 STORIES UNITS NUMBER
DESCRIBE W9RK TO BE_DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
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NUMBER
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SUITE/AP #
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Ap x0ved
Rw permit Required 13
13
EXISTING — PROPOSED
Street Use permit Roq'd
inspection Required [3
Sidewalk Required E3
REQUIRED DEDICAIION_ FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTU RES
PRV REQUIRED 0
YES0 NO
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REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION BOND
REO'D POSTED
10YES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPI ALLOWED I PROPOSED ALLOWED PROPOSED
EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRO14T L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ'D I PROVIDED I
REMARKS
CHECKEDBY ITYMF U TON rnV
GROUP
OCCUPAV
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YE [LOAD
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REO'D F3
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VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
Building Permit ;City Surcharge
PLAN CHECK N�j
I VESTED DATE
Plumbing
III
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT*. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
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ALL CLAIMS FOR DAMAGES OF W14ATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
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NOR LIMIf IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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-
CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Bu
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
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ATURE (OWNER OnIAaGE 'n)
DATE SIGNED
(425)
S11
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771-0220
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ATTENTION
Off 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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Plan Chk. Deposit
Receipt #
Total Amt. Due
/11 77 —1
Receipt #
APPLICATION APPROVAL
I '�' 'i' is not a permit until signed by the
.T1,lPic alo, "his/her Deputy: and Fees are paid, and
it Opt is acknowledged in space provided.
S NATURE PATE ,
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ........... 0
M
Slab Insulation ..........
PLUMBING:
Underground ............. 0 M
C
-in ................... M
Rough 0
--11 0
0 C
Commercial Final ...... K
M
M
HEATING: z
Gas Test .................... z
-4
Gas Piping .................
CD
0
Equipment .................
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING .......................... 0 M
C CD
FRAMING ........................ 9 Cn
Q 0
Z
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation ......... >
z
Wall Insulation ........... --I
Ceiling Insulation ....... C/)
z
0
SHEETROCK NAILING ... --i
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile Illitials NIT are Miltoll
Thompson, a temporary contract q WAOf
Inspector for tile City.
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