20051148.pdfDATE RECEIVED
LPERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS
OWNER NAMENAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO.
LID NO.
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MAILING ADDRESS
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING __ PROPOSED
REQUIRED DEDICATION— FT
TESCP Approved 0
RW Permit Required 0
Street Use Permit Roq'd 13
Inspection Required *
Sidewalk Required E3
Underground
Wiring required 13
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TELEPHONE
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP
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ENGINEERING REVIEWED BY DATE
ADDRESS
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51 ST SIA )
FIRE REVIEWED BY DATE
CITY ZIP
TELEPHONE
77,!� 70MO
VARIANCE OR CU
SHORELINE OR ADB#
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INSPECTION
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OYES IIIIIINO
BOND
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STAIE LICENSE NUM13ER EXPIRATION DATE
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GUi"ED By
SEPA REVIEW
COMPLETE , EXEMPT
EXP A
SIGN AREA Cq?, 57
ALLOWED PROPOSE
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HEIGHT
ALLOWED PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO.
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REPAIR GRADING CYDS CIE X FT)
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
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PROPOSED SETBACKS (Fr.)
FRONT L/R SIDE REAR
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PARKING
REO'D PROVIDED
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LOT AREA
PLANNING REVIEWED BY DATE
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REMARKS
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OCCUPANT
GROUP
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MBER r NUMdER OF— I CRITICAL
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OF ELLING
STORIES -UNITS NUMBER
DESCRIBE WORK TO BE DONE
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SPECIAL INSPECTION
REQUIRED YES
JAREA�'
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
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VALUATION
Description
FEE
Description
FEE
Plan Check
1/90
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
Base Fe
HECK Nb VESTED DATE
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: IBODAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
2
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFN� DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY OR INDIRECTIY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
21
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I I IAVE READ THIS APPLICATION; THAT I HE INFORMATION
GIVEN IS CORRECT, AND THAT 1, 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 DO HE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIONWHIT LAB05o8qDE OF THE STATE OF WASHINGTON RELATING To
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CALL
FOR INSPECTION
APPLICATION APPRF)VAL
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.
A
WORKI� NSAT)P^#SLnANCE AND RCW 18.27.
(425)
771-0220
EXr 1333
OF A[' SIGNATU ATE
.1601 T 7Yr 111 'bATE1
SIGNATURE W ER 0 EN-n
DATE S17D/
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AT EN ION
ITISUN FULTO USE OR PYA BUILDING OR STRUCTURE UNTILAFINAL I
INSPEC ON HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- IGINAL - FIL LL0W - INSPECTOR
PANCY ASBEENGRANTED. UBC109/IBC110/IRC110. INK - OWNEUY OLD - ASSESSOR
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TINAL PROJECrt'APPROVAL FORM
TO:
DATE:
MEMOTO: PERMITCOORDINAToR, BUILDING DIVISION
FROM: FIRE DEPARTMENT DATE
PLEASh SIGN
ENGINEERING DIVISION DATE—
PIXASE SIGN
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A field inspection was conducted to determine compliance with n
approved- plans. IF i al.apprioval
denotes that there are no objections from the, -above signed Depart m*en.t to the release of
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PERr, ORMANCE BONDS and the granting of:
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GRANT FINAL PROJECT. APPROVAL:
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GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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PATFrAr) PIMAE MqUIRCTION _(')11T.qTAXFD1MC.1.R.q11Fq
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .. ..... ............
FOUNDATION:
Footing ......................
Wall.................. .......
Pier/Porch .................
Retaining Wall ..........
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Slab Insulation ..........
PLUMBING:
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Underground ..............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment .................
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATION ....... ...........
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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