20041082.pdfW
DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER-NAME/NAME OF BUSINESS .
MAILING ADDREIS 9�O
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NAME
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NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TY;WWF USE. I
ujI NUMB
'31 OF
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HEAT SOURCE
PLAN CHECK NO:
ZIP I TELEPHONE
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NO.
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
El
GRADING CYDS
13
TANK
EDRETAININGWALL
ROCKERY
3 OR ACTIVITY) EXPLAIN:
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NUMBER OF
DWELLING
UNITS
PERMIT EXPIRES 4�4�-�Z
I( / D
USE PERMIT
ZONE
NUMBER
.JOB SUITEIAPT#
ADDRESS.4 �.7
PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
7ESCP Approved
PUBLIC RIGIIT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
13
Street Use Permit Roq'd
E3
EXISTING - PROPOSED
Inspection Requited
Sidewalk Required
13
C3
REQUIRED DEDICATION- FT
Underground
Winng required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
T
YES 0 NO
0
cr
W
REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROIL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
tEfKEF BY
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
/ qMECH ALLOWED PROPOSED
CHANGE OF USE
SIGN
oFENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
I
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECfLY OR INDIRECTLY
41
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITY'S 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 AGRiE 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 ANDhCW 18.27.
ATURE (OWN OR DATE SIGNED
-,*A I /I , A �fw' 1 11 _'? leAd
SHORELINEORADB# I INSPECTION BOND
REO'D POSTED
OYES ONO S
F_
SIGN AREA HEIGHT
ALLOWE D . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT URSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE -1
a.
REO'D I PROVIDED
le lu or L vent connectors reqt
lov, fod-but ningappliances passing itL
CHECKED BY [TYPE
OCCUPANT
GROUP
nPi'110AMT
SPECIAL INSPECTION jAKhA LOAD
REQUIRED
REMARKS z
PROGRESS INSPECTIONS PER UBC 1 08/FINAL INSPECTION REQ'D a
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VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a pernnit until signed by the
Building Olficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
cj6 AAirzzirifJkLTIIPF . DATE
RE
ATTENTION A 1 1%3%3%3
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST -FLOOR FRAMING ...
1'149ULATION ...................... ..
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
S5
FINAL APPROVAL FOR
OCCUPANCY ..................
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