20041010.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSIN S
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME
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ADDRESS L7
CITY zip TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBINGC� �CFf
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
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REPAIR
GRADING
CYDS
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FENCE
( X FT)
DEMOLISH
TANK
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OTHER
oGARAGE
CARPORT
RETAINING WALL
ROCKERY
F1
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER OF CRITICAL
OF DWELLING AREAS
ST4 UNITS NUMBER
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DESCRIBE WORK TO BE DONE
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GLAZING %
CHECK NO:
LOT SLOPE %
VESTED DATE
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.
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
a:
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 MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO 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, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STNIE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIONJU&WRANCE AND RCW 18.27.
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PERMIT EXPIRES lee�Z
USE PERMIT
ZONE NUMBER .:� x M,(Z - -
JOB �UITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 0
AW Permit Required 13
Street Use Permit Roq'd 13
EXISTING - PROPOSED
Inspection Required Cl
Sidewalk Required E3
REQUIRED DEDICATION- Fr
Underground
Wiring required CI
METER SIZE
LINE SIZE
I
NO. OF FIXTURES
I
PRV REQUIRED
YES 1:3 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
On fuel-burningappliances passing
0PMFATF4fflh*Ated Rpaces. LNIC 30a.2
FIRE REVIEWED BY DATE
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VARIANCE OR CU SHORELINE OR ADBII I INSPECTION I BOND
REO'D POSTED
OYES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED OSED
EXP 'I I PROP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED SL
REMARKS
CHECKED BY FINS R�CT�; C E OCCUPANT
F i�� GROUP
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED C] YES LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/ ISC109 IIRC109 FINAL INSPECTION REO'D 3
:NACt
VALUATION
Description
AF11DAVITS :
OF ACC
FEE
Description FEE
State Surcharge
City Surcharge
A -
Base Fee IVJ
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
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1"Isapplicationisnotapermiunt sgneuuyuie
CALL Building Official or his/her Deputy: and Fees are paid. and
FOR INSPECTION receipt is acknowledged in space provided.
IALS Sl T RE DATE
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XT1'ENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
Recording Fee
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD-ASSESSon
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS, ... * ..............
FOUNDATION:
Footing ......................
Wall ........... ...............
Piey/�oTdh ..............
z
Retaining Wall ........... 0
0
Slab Insulation .......... M
PLUMBING:
Underground .............
M
Rough -In ................... C
M 0
0
—40
Commercial Final ...... 0 f-
-1
HEATING- x
M
M z
ID
Gas Test ....................
C
> Z
Gas Piping .................
Equipment ................. 0
-n
0
n
Commercial Final .......
EXTERIOR SHEATHING M M
NAILING .......................... 055
0 r-
0 M
FRAMING ........................ C CD
9 Co
FIRST FLOOR FRAMING... Q 0
Z
INSULATION ...................
tion .........
Floor Insula
>
Wall Insulation ........... z
--I
Ceiling Insulation ....... Cn
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. IY) 2_1
The Initials NIT are Milton
Thompson,a temporary contract
Inspector For tile City,