20050574.pdfV
DATE RECEIVED
FP
ERMITEXPIRES
CITY OF EDMONDS
U'Er PERMIT
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CONSTRUCTION PERMIT APPLICATION
JOB SUITEtAP'
ADDRESS 75) P0,2IE STREE-T- IV() '3
OWNER NA AME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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MAILING ADDRESS
LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP HW Permit Required 0
Street Use Permit Roq'd 0
CITY ZIP TELEPHONE
EXISTING — PROPOSED Inspection Required CI
sidewalk Required
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Underground
REQUIRED DEDICATION- FT 1 Wiring require [3
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED C3
YES 13 NO 13 3
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ADDRESS
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OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE 5
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CITY ZIP TELEPHONE
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NAME CBL
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE LU
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CITY ZIP TELEPHONE
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VARIANCE OR cu �HORELINE OR A11111 INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED By
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PROPERTY TAX ACCOUNT PARCEL NO.
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP
EErNEW 1:3 RESIDENTIAL ErPLUMBING MECH
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
13 ADDITION COMMERCIAL
CHANGE OF USE
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PARKING LOT AREA REVIEWED BY DATE
11 REMODEL ReIMULTIFAMILY El SIGN
rPLANNING
REO'D I PROVIDED
GRADING Ei FENCE
1:1 REPAIR 1:1 CYDS ( x FT)
REMARKS
M DEMOLISH 1:1 TANK OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
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(TYPE OF USE, BUSINESS 013 ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
SPECIAL INSPECTION AREA OCCUPANT
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STORIES UNITS NUMBER
REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
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REMARKS
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PROGRESS INSPECTIONS PER LIBC 108/ IBC109 ir IRC109 FINAL INSPECTION REO'D
VALUATION
$
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK INO%, VESTED DATE
Plumbing
Base Fee
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Mechanical
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THIS PERMIT AUTHORIZES ONLY THE`W&K NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
—
Engr. Review
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LU PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
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Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMi ESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC11Y
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHAI. I NOT 13E
Landscapelnsp.
Total Arnt. Due
5 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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Recording Fee
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
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APPLICATION APPROVAI
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DUL AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STA:rE LAWS REGULATING CONSTRUC
CALL
This application is not a permil until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO 13ERSON WILL 13E EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt isacknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
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OFFICIA1 S SIGNATURE TE
SIGNA IN T: ' DA1E SIGNED
(425)
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771-0220
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PfLEASED BY, DATE
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ATTE-NTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL. OR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW-4INSPEAR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
CD
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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