20050003.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO. j -�N
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NEW RESIDENTIAL
ADDITION COMMERCIAL
REMODEL MULTIFAMILY
REPAIR El GRADING CYDS
DEMOLISH TANK
o GARAGE RETAINING WALL
z CARPORT ROCKERY
MPE OF USE, WMESS OR ACTIVI, "M
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M NUM13ER NUMBER OF
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ol STORIES UNITS
I �DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING %
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M LIANCE OR
CHANGE OF USE
SIGN
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OTHER
FIRE SPRINKLER
FIRE ALARM
PERMIT EXPIRES
USE
ZONE
PERMIT
NUMBER
JOB
ADDRESS 7 z1vi
SUITO
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved [3
RW Permit Required Q
EXISTING —
PROPOSED
Street Use Permit Roq'd [3
inspection Required El
Sidewalk Required [3
REQUIRED DEDICATION— FT
Underground
Wiring(equired E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
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YES14 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
NEERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
117AIDI
SHORELINE OR ADBI I INSPECTION I BOND
REO'D POSTED
E]YES ONO IS
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED . PROPOSED
(3
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING I LOT AREA rLANNING REVIEWED BY DATE
REQ'D I PROVIDED
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GROU PANT
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CRITICAL
AREAS
NUMBER
],PROGRESS
SPECIAL INSPECTION
REQUIRED [:] YE
JAREA
OCCUPANT
LOAD
REMARKS
INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
LOT SLOPE %
PLAN CHECK NO: In i VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
3
I= SEPARATE PERMISSION.
it
uj PERMIT APPLICATION: 180 DAYS
EL PERMIT LIMIT! I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) '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 NAT URE, ARISING DIREC TLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT 13E
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. -
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 1APOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PEN fATAAKqU RANCE AND RCW 18.27.
ATURE (OWNER,rN DATE SIGNED
VALUATION
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
EXT 1333
FEE Description
State Surcharge
City Surcharge
1.7n Base Fee
Ei
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
&� VY'
APPLICATION APPROVAI
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
`1
:EICIALS-SIGNATURE DATE
It -IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
13Y
FILE -JELLOW - INSPECTC
INER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
z
0
Slab Insulation ..........
0,
M
PLUMBING:
Underground .............
—4
0
Rough -In ...................
rn
C
M
Commercial Final ......
0
0
C:
HEATING:
—1
X M
M z
Gas Test ....................
ID —4
Gas Piping .................
C z
—4
Equipment .................
C/)
Commercial Final .......
0 -n
EXTERIOR SHEATHING
rn M
NAILING ..........................
0 Cn
0
FRAMING ........................
0 M
C Cn
FIRST FLOOR FRAMING...
Cn
M 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulatioh ...........
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Ceiling Insulation .......
Cn
SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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