20050553.pdfDATE RECEIVED
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P ERMIT EXPI
ERMIT EXPIRES
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
USE PERMIT
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NUMBER
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ADDRESS
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OWNER NAME/NAME OF BUSINESS
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PLAT NAME/SUBDIVISION NO. LOT NO, LID NO.
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LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
TESCP Approved 13
RW Permit Required El
street use Permit Flaq'd C3
inspection Required 13
Sideivalk Required [3
Underground
Wiring required 13
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METER SIZE
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NO. OF FIXTURES
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PRV REQUIRED
YES 1:1 NO 13
ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CITY ZIP
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TELEPHONE
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ENGINEERING REVIEWED BY DATE
ADDRESS
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VA RIANCE OR CU
SHORELINE OR ADBI
INSPECTION
REO'D
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STATE LICENSE NUMBER EXPIRATION DATE
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SIGN AREA
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HEIGHT
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PF19PERTY TAX ACCOUNT PARCEL NO.
NEW ESIDENTIAL PLUMBING MECH
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IgADDITION COMMERCIAL CHANGE OF USE
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LOT AREA
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GRADING FENCE
REPAIR CYDS 1:1 ( X FT)
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GARAGE -1 RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY El FIRE ALARM
(TYPE OF UqE, BUSINESS OR ACTIVITY) EXPLAIN:
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CHECKED BY
TYPE OF CQNSTRUCTION CP
OCCUPANT
GROUP
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NUMBER
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NUMBER OF
DWELLING
UNITS
CRITICAL
AREAS
NUMBE 7-
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SPECIAL INSPECTION
REQUIRED YES
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_ECCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROG RESS INSPECTIONS PER UBC 108 ir IBC1759 IRC 109 FI NAL INSPECTION REQ'D
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
tiEAT So ; IURCE
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LOT.ZOPE %
Building Permit
City Surcharge
. 15
PLAN CHECK
VESTED DAfE
Plumbing
Base Fee
Mechanical
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THIS PERMIT AUTHORIZES ONLY THt 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
Grading
SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS ]'HE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NA1 URE, ARISING DIREC FIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIIY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION'
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt III
Landscapelnsp.
tal Amt. Due
"7/4-/..
Recording Fee
Receipt #
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
APPLICATION APPROVAL
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 LABORPQ FATNIDE STATE OF WASHINGTON RELATING TO
S
WO��N)S COMPE�f ATIOY/6 S U RVA N�E RCW 18.27.
CALL
FOR INSPECTION
(425)
771-0220
I his application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
receipt is ackpwiedged in space provided.
0 -ICI L SIGNATUt D TE
RELEIIED BY E
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DATE SIGNED
EDITION EXT 1333
ITISU LAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL 11j AWT i
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- I, I
I FILE YELLOW - I SPECTOR
ORIG
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110. PIN�o W_NEn GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING: --I -n
Underground .............
M
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Rough -In ................... M
0
0
0
Commercial Final ...... C
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M
HEATING: M Z
Gas Test .................... C
Gas Piping .................
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Equipment ................. 0 _n
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Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING.......................... 0
0 M
C CD
FRAMING ........................
C Cn
Q 0
FIRST FLOOR FRAMING ... Z r-
INSULATION ................... ;U
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Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ... —I
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SPECIAL INSPECTION M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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