20040977.pdf112
DATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP
TELEPHONE
NAME CBLft
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ADDRESS4 _TL'
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CITY
ZIP
TELEPHO NE
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STATE LICENSE NUMBER
EXPIRATION DATE
Y
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PROPERTY TAX ACCOUNT PARCEL NO.
00SNI-0
00 0 (1> 0 00
RESIDENTIAL
fxNEW PLIJMBING� �CH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING " FENCE
CYOS ( X Fr)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
ITICAL
OF
DWELLING
EAS
STORIES
UNITS
MBER
DESCRIBE WORK TO BE DONE
LA CC 6'k I 4,r�-rl M Gr C:b puid
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
LOT SLOPE %
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 (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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 INDEMNIF'� DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, US 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 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.4
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAI 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-rQDE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIOMNSURANCE AND RCW 16.27.
Slql A UPE (OWNER tAGE'NTN1f\/-'N DATE SIGNED
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PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
L
JOB
ADDRESS SUITE�APT;�
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
'ESCP '"I""'W"d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP SW p,,,,t Required
Sueet Use permit Req'Id
EXISTING - PROPOSED Finspection Required
"'I"
Sidewalk Required
underground
REQUIRED DEDICATION- Ff Wiring required
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
I I YES [3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING
DATE
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FIRE REVIEWED BY DATE
FI R E EV 'EWE
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VARIANCE OR CU
A RIR E OR
SHORELINE ORADBI
INSPECTION
BOND
REO'D
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POSTED
OYES ONO
$
SEPA REVIEW
S EPA RE
COMPLETE EXEMPT
rEXP
SIGN AREA
ALLOWED PROPOSED
HEIGHT
ALLOWED PROPOSED
,
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
LOT AREA
I PLANNING REVIEWED BY DATE
CL
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION JAREA
REQUIRED 1:1 YES I
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS I oz-
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC1W FINAL INSPECTION REQ'D El
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing Base Fee
Mechanical L4 0
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt N
LandscapeInsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
s application is not a permit until signed by the
CALL B din Official or hisfqe Deputy: and Fees are paid, and
FOR INSPECTION receipt is ac6owladged in space provided.
Ovl� I
AA S SIGNrj WE
(425)
0 4a wk,
771-0220 ('RE EASED BY D Te
ATTENTION t:'A 1 1
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
PANCY HAS BEEN GRANTED. UBCJ09/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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Z
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ........... z
0
Slab Insulation ..........
M
PLUMBING:
Underground .............
--I
Rough -in ................... M
C
M 0
Commercial Final ...... 0
0
0
HEATING:
M
M Z
Gas Test ....................
Gas Piping ................. C z
Equipment ................. M" '7 05
-n
Commercial Final ....... 0
EXTERIOR SHEATHING
M
NAILING.......................... M
C0
0
FRAMING ........................ r-
0 M
C
FIRST FLOOR FRAMING ... 9 Cn
Q 0
Z
INSULATION ...................
Floor Insulation ........
Wall Insulation ...........
z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... I
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR Z.3
OCCUPANCY ..................
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The Initials NIT are Miltoll
Thompson, a temporary contract
inspector for tile City.