20050157.pdfFDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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STATE LICENSE NUMBER
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LID FEE S
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REMARKS
RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
OWNER/CONTRACTOR
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ENGINEERING REVIEWED BY
DATE
P Z_ N CHECK N 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 APPUCATION: 160 DAYS
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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
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
OR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ALL CLAIMS F
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITTS 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.
ATE SIGNED
SIGN4TURE (O�MER AG%
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FIRE REVIEWED By
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION BOND
REO'D POSTED
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SEPA REVIEW SIGN AREA
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS PROPOSED SETBACKS (FT.)
ALLOWED SIDE REA RONT IJR SIDE REAR
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DATE
PARKING LOT A EA PLANNING REVIEWED BY
REO'D PROVIDED
REMARKS
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CHECKED BY ITYPE (2F_L;Yr4z11MUL011U11i ) GROUP
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OCCUPANT
SPECIAL INSPECTIO LOAD
REQUIRED [3 YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108 / IBC109/ IRC109 FINAL INSPECTION FILEQqD Z
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mecha iical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
[Lan:ddsca:pelnsp.
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Recording Fee
FEE :#Description FEE
State Su
State Surcharge
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ity Surclharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
EXT 1333
44
ATTENTION—-` G OR STRUCTURE UNTILAFINAL -L L
ITIS UNLAWFULTO USEOROCCUPYABUILDIN _Ad
E AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - IN6ECYO/R
INSPECTION HAS BEEN MAD UBcj og / IBC1 10 / IRC1 10. PINK - OWNER GOLD - ASSESSOR
FANCY HAS BEEN GRANTED.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Otlicial or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
DATE
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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:
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
OCCUPANCY ..................
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