20041048.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PLAT NAMEISUBDIVISION NO.
I PERMIT EXPIRES
PERMIT
NUMBER,-
UITE1APT#
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
qo ;/10 1] REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROP
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
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RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAININGWALL
ROCKERY
ESS OR ACTIVITY) EXPLAIN:
NUMBER el
I NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
�ECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
I X FT
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
XREAS
NUMBER
LID N?.
LID FEE $
TESCP Ap)foved
13
RW permit Floquired
13
Street Use permit Fleq'd
13
Inspection Required
Q
Sidewalk Floquirod
E3
Underground
wiring required
E3
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTPIOL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU PHORELINE OR ADB# INSPECTION BOND
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SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP _j
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA PLANNING REVIEWED BY ATE 104
REQ' PROVIDED
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REMARKS
CHECKED BY CC1 OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
LOAD
CN_�REQUIRED
C U I D C YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
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Y FEE
Nli fflf�UV j Description FEE Description
Plan Check State Surcharge
HEAT d�URCE LOT SLOPE % Building Permit City Surcharge
PLAN ICHECK NO: P-�-7 VESTED DATE Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, 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 PERL41T FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOT 0 HARMLESS THE CITY OF
E EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
C ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
C FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1111S PERMIT SHALL NOT 13E Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY I HE cinrS ABILITY TO ENFORCE ANY ORDINANCE PROVISION -
r Recording Fee Receipt it
I HEREBY ACKNOWLEDGE THAT I HAVE READ TIIIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF I his application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Building Offirial or his/her Deputy: and Fees are paid, and
TION AND IN DOING TIIE WORK AUTHORIZED IIIEREBY, NO PERSON WILL BE EMPLOYED
IN V61LATION OF THE LABDR,CODE OF THE STATE OF WASHINGTON RELATI�G TO FOR INSPECTION- receipt is acknowledged in space provided .
WORKMEN'S COMPENS2!�RANCE AND RCW W.27, OFFICIALS SIGNATURE DAT[
S7NIIII DA)j,'j 'N (425)
771-0220 Y DAIE
4
A-rr1=NTION CA 1 1%3%313 1 1 1.4. /1 j /) //-
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADEAND APPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE --YELLOVV-INSPECTC
PINK -OWNER - GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
.4 r e, tA
Pier/Porch .....
MX
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 V-)
OCCUPANCY ..................
The Initials wr are Milton
Thompson, ,I temporary contract
inspector for thc City.
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