20041013.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BU7SN SS
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MAILING ADDRESS
CITY ZIP TELEPHONE
OT
NAME
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t ADDRESS
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CITY ZIP
ADDRESS
216�- q
TELEPHONE
TELEPHONE
PERMIT EXPIRES
USE PERMIT
ZONE NUMBERA/,)
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
I ESCP Approved [3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use Permit Raq'd 13
EXISTING - PROPOSED inspection Required 13
Sidewalk Requited 13
REQUIRED DEDICATION- FT Underground
Wiring required E3
METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
I I I YES 13 NO 11
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
CBL #
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&j EVIEWED BY
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STATE LICENSE NUMBER
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PROPERTY TP ACCOUNT PARCEL NO. �
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NEW
�61ESIDENTIAL
PLUMBING I MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
FENCE
CyDS El ( X FT)
GRADING
DEMOLISH
TANK
M OTHER
GARAGE
RETAINING WALL FIRE SPRINKLER
El ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE, BUSINESS OR ACTIV" EXPLAIN: J�ItTe
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
I
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
A
ri
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADIIII I INSPECTION
REGO
OYES ONO $
GN AREA 1-
D . PROPOSED I ALLOWED
BOND
POSTED
HT
PROPOSED
M
W
z
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (IFT.)
FRONT SIDE REAR FRONT L/R SIDE REAR ED
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PARKING LOT AREA �PLANNING REVIEWED BY D E
REO'D I PROVIDED I
REMARKS
CHECKED BY I TYPE OF
GROUP
SPECIAL INSPECTION ]AREA ULAWFANI
REQUI LOAD
13
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/iBC109/IRC109 FINALINSPECTION REQ'D
A11110T D�:
VALUATION
Description
FEE
Description
FEE_
Plan Check
State Surcharge
HEAT SOURCE GLA21NG 9�, LOT SLOPE %
Building Permit
City Surcharge et;`
PLAN CHECK NO: VESTED DATE
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 (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
x PERMIT APPLICATION: ISO DAYS
.0
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
La 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
ANY AND
Receipt #
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM
Fire Inspection
M ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0� NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
x
Receipt It
Recording Fee
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
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 Otlicial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
0 LS I N URE DATE
S E(9WNER AG D A�E 1 ` ED
(425)
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771-0220
RELEASED BY
Ai-TE' NTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL -FILE - YELLOW- INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ........... 0
171
Slab Insulation ..........
PLUMBING:
Underground ............. 0 M
C7- 0
M
Rough -In ................... 0
0
0 C:
Commercial Final ......
M
M z
HEATING:
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Gas Test .................... >
GasPiping .................
ch
0 -n
Equipment .................
Commercial Final .......
M M
0
EXTERIOR SHEATHING Cn
0 r—
NAILING .......................... 0 171
C: cn
9 cn
FRAMING ............ I ...........
M 0
Z r
FIRST FLOOR, FRAMING.. -A
INSULATION .: ...................
Floor -Insulation ......... >
z
Wall Insulation ...........
Ceiling Insulation .......
z
0
SHEETROCK NAILING ... i
0
SPECIAL INSPECTION ... ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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