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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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CITY ZIP
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50 o. y of
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STATE LICENSE NUMBER
EXPIRATION DATE
5 UAVE-5o 6 --3,J-r-/
7-11-05-
PROPERT)k,TAX_ ACCOUNT PARCEL NO
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
F-1 APARTMENT
F-1 REPAIR
GRADING CYOS
DEMOLISH
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GARAGE
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HEAT SOURCE i GLAZING%
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COMPLIANCE OR
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PLAT NAME,SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
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LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXIFTING — PROPOSED
REQUIRED DEDICATION-- FT
METER SIZE I LINE Sil E I NO. OF FIXTURES
LLL/L?_�,
SUITDAPT"
LID NO.
LID FEE S
T—ESCP Approved
pW permit Requited
street Use permit Req d
inspection Requited
Sidewalk Required
underground
Wiring required
PRV REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE,
ENGINEERING
FIRE REVIEWED BY
REVIEWEENDATE
DATE
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SERA REVIEW
SIGN AREA
ALLOWED PROPOSED
LLOW HEIGHT
ALLOWED PROPOSED
COMPLETE
EXEMPT
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EXP
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LOT COVERAGE
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REQUIRED SETBACKS (FT1
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED By DATE
REO'D I PROVIDED
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CRITICAL
AREAS SPECIAL INSPECTOI
NUMBER REQUIRED E] YES
LOT SLOPE 0,'.
ESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
ANY CONSTRUCTION ON THE PUBLIC
BE DONE ON PRIVATE PROPERTY ONLY C.) WILL REQUIRE
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ET
SEPARATE PERMISSION,
a: PERMIT APPLICATION: i8o DAYS
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PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
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SEE BACK OF PINK PERMIT FOR MORE INFORMATION
L C GNS AND SUCCESORS
W "APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSI
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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ROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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a DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR IMIT IN ANY WAY THE CITY'S 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
THEOWNER I AGREE 10 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 COM PEN SAT��k5,�RANC E AND RCW 18.27
SIGNATURE (OWNER OF AGEN T' DATE SIGNED
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OF CONSTRUCTION
REA
OCCUPANT
GROUP le
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'Dj z5
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GAS PIPE TEST MUST BE co
OBSERVED BY CITY INS TOR
VALUATION
rP PLAN CHECK FE
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LAN C
C HECK FEE
ISUILDING
PLUMBING
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MECH ANICAL
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PAID N �111 I I
ATT ENTION
IT IS UNLAWFUL TO USE OR Or_;CUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADF AIINvIn APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED, UBC SECTION 109
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ENG. REVIEW FEES
ENG. INSPECTION FEE
LANDSCAPING
INSPECTION FEE
RECEIPT
PLAN CHECK DEPOSIT
REC
TOTAL AMOUNT DUE
CALL
FOR INSPECTION
(425)
gin
771-01M
EXT 1333
771-0221
FAX
FEE
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputli� and ;oes are paid. and
� receipt is acknowledged in space provided.
�J4A)S SIGNATYRE) DATE,
ORIGINAL - PILE YELLOW - INSPECTOR
PINK - OWNER GOLD . ASSESSOR
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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 ....................
GasPiping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING....
INSYLATION ..................... I
.:..F.lo6r Insulation .........
Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
_64
OCCUPANCY ..................
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