20040981.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIR TION ATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
(5129/M � - / 7A91
NEW 11 RESIDENTIAL
PLUMBING / MECH
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El REPAIR 11 CYDS
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECeKBO: , , / � I VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,) WILL REQUIRE
SEPARATE PERMISSION.
tr PERMIT APPLICATION: 1180 DAYS
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CLI PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'Uo) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
�j IN INTEREST. AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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,x ALL CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECItYOR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMII SHALL NOT BE
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_j DEEMED TO MODIF� WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CIFYS ABIL11Y 10 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. On THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CIT'Y AND STATE ILAWS REGULATING CONSTRUC-
TION ' AND IN DOING THE WORK T 10 D THEREBY, NO PERSON WILL BE EMPLOYED
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V'O=ION OF THE LABOR C�ODE G�F HE STATE OF WASHINGTON RELATING TO
,S COMPENSATION INSURANC ND RCW 18 27.
WORK 'At
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PLAT NAMEISUBDIVISION NO.
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LOT NO./
LID NO.
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LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREEr MAP
TESCP Approved 13
RW Permit Required Q
Street Use Permit Roq'd [3
EXISTING PROPOSED
Inspection Required E3
Sidewalk Required 13
REQUIRED DEDICATION FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES [3 NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
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SPECIAL INSPECTION JAREA OCCUPANT
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTIO,N REO'D
VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt #
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Total Amt. Due
Receipt #
APPLICATION APPROVAL
I his application is not a pernut unfil Signed by the
Building Official or his/her Deputy. and Fees are paid, and
receipt is acknowledged in space provided
:FICA1 S,1SIGN DATE
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ATTENTION /
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EXT 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION
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PINK - OWNER GOLD - ASSESSOR
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PRESS HARD -YOU ARE MAKING 5 COPIES
GREEN ACCOUNTING
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MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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—ENGINEERING DIVISION DATE
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DESCRIPTION OF WORK TO BE INSPECTED XON Z
A field inspection was conducted to determine compliance with -approved plans. Final approval
dei I iotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
7" GRANT FINAL PROJECT APPROVAL
GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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FAILED FINAL INSPECTION - OUTSTANDING ISSUES
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date SignatUre
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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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