20041002.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF 13USINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME
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ADDRESS
CITY
ZIP
ELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED By
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PROPERTY TAX ACCOUNT PARCEL NO.
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1:1 NEW
�Q_MSIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
13 In. Y r).q X Fr)
DEMOLISH
TANK OTHER
EiGARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPO
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRI13E WORK TO BE DONE
&A
1(j&,,l _I PERMIT EXPIRES
�JSE PERMIT
ZONE NUMBER,4
JOB %
ADDRESS
TE/APT#
PLAT NAME/SUBDIVISION NO. LOT NO,
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
AW Permit Required
13
0
Street Use Permit Roq'd 13
EXISTING - PROPOSED
Inspection Required
13
Sidewalk Required
E3
REQUIRED DEDICATION- FT
Underground
Wiring required
[3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO
13
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ACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
OYES ONO s
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LiRSIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
REMARKS
CHECKED BY I TYPE ��Y)IS?
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1 77 GROUP Id
;k I OCCUPANT
SPECIAL INSPECTION' JAREA UUL;UVAN I
REQUIRED [I YES I LOAD j
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REMARKS 2
PROGRESS INSPEC11ONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQrD
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VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
. N
Base Fee
M" — ____
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Lit PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOAS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS A131LITY TO ENFORCE ANY ORDINANCE PROVISION.*
MI
Recording Fee
Receipt #
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
APPLICATION APPROVAL
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 AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
WORKPEN'S COMPENSA��- Sd�ANCE AND RCW 18.27.
OFF��i TU DATE
SIGN*UF1yikOWN DATE SIGNED
(425")
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C.
LOLGENLT)
771-0220
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�DATE
Rrl.EAc---
7,AE7NITION
Off 1333
ITII NLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
T W
INSPECTION
HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC1I0-
PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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(dW6)
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
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Gas Test .....................
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Gas Piping .................
Equipment ................. AA T
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 ..................
The Initials Ware Milton
Thompson, a tel"1)01*,"'Y contract
inspector for tile City.
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