20041065.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
MAILING ADDRESS not
IT 30 2. --
CITY ZIP
NAME
I CITY
NAME
C "
ADD
Z15
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STATE LICENSE NUMBER
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
ZIP
IFtEPHONF
TELEPIONE
ZI
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A
PARCEL NO.
)100050,':
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
913 ACTIVFFYI EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES J UNITS
DESCRIBE WORK TO BE DONE
I
op
HEAT SOURCE
PLAN CHECK NO -
CBL a
PHONE
RON DATE
191PLUMBING I MECH
El
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X Fr)
OTHER
FIRE SPRINKLER
FIRE ALARM
VX1_1
PERMIT EXPIRES
USE PERMIT
ZONE NUMBER 1414
JOB SUITE/APT#
ADDRESS .74
PLAT NAM EIS UBDIVI SION NO. LOT NO. LID NO.
LID FEE $
TESCP ALprurived
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit Roq'd E3
EXISTING - PROPOSED inspection Required E3
Sidewalk Required E3
Underground
REQUIRED DEDICATION- FT Wiring required E3
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I I YES 13 NO 13
REMARKS
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In addition to the requii
I pressure/relief valve, a
gr
LU
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I LTPC 608
FIRE REVIEWED BY DATE
Ul
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VARIANCE OR CU
S HORELINE OR ADB#
INSPECTION
BOND
REQ'D
111YES
POSTED
EINOIS
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
,
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
0
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PARKIN - G
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LOT ARET_[�ILANNING
REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED BY
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10 .3
OCCUPANT
GROUP
CRITICAL
AREAS
SPECIAL INSPECTION
SPECIAL
IWA
OCCUPANT
NUMBER
REQUIRED
LOAD
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LREMARKS
PROGRE, 1NSVEGTjp.N$.pg8_WQ,0& �IRQ1,09 IRCII D9 FINAL INSPECTION REQ'
'1�pe R or L vent connectors 7requ:ir7ed
;lAl"' 114*e—
Passing
GLAZING % I LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIMI YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS 'THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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 STATE 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 COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (OWNER AGCNT) DATE SIGNED
/J
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt IV
Total Amt. Due
Receipt # Jot
APPLICATION APPROVAL
I tus application is not a pernift until signed by the
isjul(juig ollicial or tusiller Deputy: and Fees are paid, and
;uculpt is acknowledged in space provided
IAI�� �I(j/NA/)URF DATE
r
FFI FAsro ny
ATTENTION tyk I
IT IS UNLAWFULTO USE OR OCCU PYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU-
PANCYHAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW . INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ........ .........
FOUNDATION:'
Footing ......................
Wall............ : .............
Pier/Porch .................
Retaining Wall ........... z
0
Slab Insulation .......... I
0
ITI
PLUMBING:
Underground .............
--j
Rough -In ................... M
C:
Commercial Final ...... M
0
0
EATING: 0 C
H --I K
3: M
Gas Test .................... ITI z
Gas Piping ............ mr
C z
Equipment .................
Cn
Commercial Final ....... 0 -n
-n
EXTERIOR SHEATHING
NAILING .......................... M M
1--�---.�—,..—.�FRAMIN)G*'.'..'..* . .................. 0
0
ITI
C: 0)
OR Fp�M!1INp-
9 C0
ITI 0
INSUVAbON-...� Z r-
Floor Insulation ......... ;U
Wall Insulation ...........
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Ceiling Insulation ....... --I
3:
SHEETROCK NAILING ... cn
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SPECIAL INSPECTION 0
I
1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
'rile Initials Ware Milt011
nioillpson, a temporary contract
inspector for tile City.