20041011A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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NAME
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STATE LICENSE NUMBER
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PROPERTY TAX ACCORPNT PARCEL NO.
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RESIDENTIAL
El PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
F-1 REPAIR
GRADING
CYDS
FENCE
( X FT)
DEMOLISH
[3'0"TANK
OTHER
GARAGE
CARPORT
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ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER
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PLAN CHECK NO: I VESTED DATE
PERMIT EXPIRES
USE PERMIT
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
I ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required 13
Street Use Permit Req'd Q
EXISTING - PROPOSED inspection Required 13
Sidewalk Required 0
Undosground
REQUIRED DEDICATION. FT Wiring required 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE a
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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SEPA REVIEW
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LOT COVERAGE
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SHORELINE OR ADB# INSPECTION BOND
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OYES ONO S
SIGN AREA HEIGHT
ALI OWED . PROPOSED I ALLOWED . PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY DATE
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REMARKS
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SPECIAL INSPECTION JAREA OCCUPAIN I
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PROGRESS INSPECTIONS PER UBC 1081IBC109/IRC109 FINAL INSPECTION REO'D
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VALUATION
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Description
FEE
Description
Plan Check
State Surcharge
Building Permit
City Surcharge_
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
P
FEE
V) OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND 1101-D HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NA1 URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF TH ISSUANCE OF THIS PERMIT SHALL NOI BE
IS PERMIT Landscapelnsp. Total Amt. Due
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
X1 Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT 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
I AGREE 10 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed by the
THE OWNER. CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COM PEN SAT19;�ANSU RANGE AND RCW 18 27. 11 'URE DATE
SIGNATURE (OWNER OR GEN, DATE NED (425)
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c U�' UQ,-C- 771-0220 R f.:L ASED BY ATE
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. jBCjoq/IBC110/lRC1l0. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FINA PROJECT APPROVAL FORM
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DATE:
MEMO TO: PE ORDINATOR. BUILDING DIVISION
FROM: rAl� SIGN - FIRE DEPARTMENT DATE_ Z
ENGINEERING DIVISION DATE-
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PLANNING DIVISION DATE 0
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DESCRIPTION OF WORK TO BE INSPECTED
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A field inspection was conducted to determine final compliance with approved plans. Final approval
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a Copy of CORRECTION NOTICE given to owner/contractor by inspector
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RE -INSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Sign -----
ocaprvl.doc.l:tenip:bldg:formslO/01
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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