20050303.pdfDATE
CITY OF EDMON
CONSTRUCTION PERMIT APPLICATION
OW 1111�/NAME
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TATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
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1:1 NEW �>KRESIDENTIAL PLUMBING MECH
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING o FENCE
REPAIR CYDS
( — x FT)
DEMOLISH TANK OTHER
z 1xQbl R 1 2 BOB# TAINING WALL FIRE SPRINKLER
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NUMBEA/ 0�_
DESCRIBE WORK TO BE DONE
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK. NO.-(/,, VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: 1180DAYS
06 PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 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 T11AT 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,22�SATION INSURANCE AND RCW 18.27.
SIGNATU��EW AGENX/9
DATE SIGNED/
PERMIT EXPIRES
USE PERMIT
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ADDRESS S-UITE/APT#
PLAT NAME/SUBDIVISION NO, LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
HW Permit Required
street us a Pe " oq'd
EXISTING PROPOSED inspection ftqted
Sidewalk Required
REOUIRED DEDICATION rT Underground
Wiring required C3
METER SIZE LINE SIZE NO. OF FIXTURES P RV REQUIRED
ij= 01 YES13 NO 0
REMARKS
OWNER/CON'fRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ1D
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Description
FEE
Description
FEE
Plan Check
Building Permit
Plumbing
State Surcharge
City Surcharge
Base -Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt # f
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided,
_0FFI CIALS SIGNATURE DAT E::
(4205)
771-0220 7"RE ASED BY
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IT IS UNLAWFUL TO USE OR OCCUPY A I D i i V_
BUILDING UCTURE UNTIL L
"AS PLE-N MADE AND APPROVAL OR A CERTIFI- ORIGR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
YELLOW - INS*_CTC
GOLD -ASSESSOR
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GARY HAAKENSON
C TY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS, WA 98020 (425) 771-0220 FAX (425) 771-0221
Website: wwwxi.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
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August 19"", 2005
Frederick West
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9412 l7th Ave NE
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Seattle, Wl� 98115
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RE: Pet -rilits numbered 2005-0303 (Carport & D/W) and 2005 -0304 (Shed)
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Dear Frederick West:
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all oil 8/19/ listed above
I am writing as d follow Lip to my telephone c 05. The penii
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were issued under the 1997 Uniform Building,Code which requires an inspection within
the first 180 days (6 months). from permit issuance. If an inspection is not perfon-ned
during the first 180 days the permit is considered abandoned. , Please call for an
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inspection on each of the above listed pen -nits BEFOR -E October 2 1", 2005 in order to
maintain the validity of your permits.
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Please be advised, if you fail to complete at least one inspection for each permit prior to
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October 21", 2005 Your perrilit will expire by limitation and new plans under tile current
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Interriat ional Building Code, new plan review fees and new permit fees will be required..
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If you have any questions please don't hesitate to contact me at 425-771-0220.
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Sincerely;
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Theresa Umbaugh
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Perillit Coordinator
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Incorporated Aug st 1.1, 1890
sister CitV - Hekinan, Japan
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
..........................
Pier/Porch .................
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Retairifflig Wall ...... 0
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Slab Insulation ..........
PLUMBING:
Underground ............. Cl) -1
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Rough -in-.. .................
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0
Commercial Final ......
0 0
C:
HEATING:.
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Gas T6st ....................
Gas Piping ............... >
3:
EcfuV06Kt .................
Commercial Final ....... _n
EXTERIOR,SHEATHING M M
NAILING .................
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FRAMING .......................... C co
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FIRST PR FRAMING... Q 0
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INSULATION � ...................
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Floor Insulation .....
X
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Wall Insulation ........... z
Cellinq, Insulation .......
SHEEti�d_W NAILING z
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SPEC(At-'MSPECTION ...
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MISCELL.,,k OUS ..........
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�FINAL APPROVAL FOR L
OCCUFiXN6 ..................
Pecellpt
AMPut Paid $
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