20040985.pdfDATE RECEIVED
PERMIT EXPIRES
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7�KE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/API #
ADDRESS
OWN�"AME/NAME OF BUSINESS
_Lbtu_Ne0 N PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRES� LID FEE $
�A� MSCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
street use Permit Req'd 0
GtTly I NE EXISTING — PROPOSED i Inspection Required [3
ZIP TELEPHO I ' Sidewalk Required 0
REQUIRED DEDICATION— FT Underground
o----) I — Wiring required [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES13 NO 1:1
ADDRESS
CITY ZIP ITELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CtiECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
004c?j (XX�01-70-D-
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FIRE SPRINKLER
1:1 FIRE ALARM
(TYPE OF UIS15, BUSINE OR ACTI ITY) EXPLAIN:
S� e'rs &J�a
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS A/ 4 1 NUMBER
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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PROPOSED SETBACKS (FT)
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GIAZING % LOT SLOPE %
Building Permit
City Surcharge Ji
PLAN CHECK_p 0: VESTED DATE
Plumbing
Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONL ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT.' 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICAN 1. ON 6EHAi F OF HIS OR HER SPOUSE. I 1EIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES 10 INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGI'ON. ITS OFFICIALS, EhIPtOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
cc ALI, CLAIMS FOR DAMAGES OF WHATEVER NAI UnE, ARISING DIRECTLY OR INDIRECT Ly
x FROM THE ISSUANCE OF THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
Orll
a DEEMED To MODIF)� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN A14Y WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee
I Receipt
2
I HEREBY ACKNOWLEDGE THAJ` I HAVE READ THIS APPLICATION. THAT THE INFORMATION
.
APPLICATION APPROVAL
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
This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING To
FOR INSPECTION receipt is acknowledged in space provided.
wo�)MEN'S COMPENNTION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DAT:
TuRT(,rNEj OVAGN DATE;G -'D
(422 5)
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771-0220
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REI EASED I)Y
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EXT 1333
I It W/
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
,
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU-
ORIGINAt -FILE�) YELLOW - ASPECTOR
HAS BEEN GRANTED. UBcjo9/IBC110/IRC110.
PINK.6*NE GOLD -ASSESSOR
FrANCY
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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:
GasTest ....................
Gas Piping .................
Equipment.................
Final
commercial .......
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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