20040956A.pdfLl
DATE RECEIVED / �//
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
�NAME OF BUSINESS
MAILINGADDRES
7,tA. /Y
CiTY Z IP ELEPHONE
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ADDRESS
NAME
ADDRESS
771 Ai 01) -
CITY ZIP I TELEPHONE
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STATE LICENSE NUMBER EXPI ATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL t�_PLUM
COMMERCIAL
PERMIT
NUMBER Z'oi)
JOB
ADDRESS
PLAT NAM EISU B DIVISION NO
PERMIT EXPIRES
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7 e
-1 LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED__ —
REQUIRED DEDICATION FT
METFR SIZE LINE SIZE NO OF FIXTURES
I
SUITEIAPTP
LID NO
LID FEE S
TESCIPApproved
RW Pomid Required
Seect use Permit Roquirerl
Inspection Required
Side�jlk Requirec!
Undutgtound
Winno reouired
PRV REQUIRED
YES 13 NOO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
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FIRE REVIEWED By
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ADDITION
E:] MIXED USE
CHANG�E OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT.)
DEMOLISH
TANK
OTHER
GARAGE
Ei
RETAINING WALL
Ei
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLi)_ft
UJI NUMBER NUMBER OF
0 OF DWELLING
Cal UNITS
0 STORIES I
DESCRIBE WORK TO BE DONE _7�V-5
116 11-av ad's z1glze2
-F—VESTED DATE
HEAT SOURCE LOTSLOPE%
PLAN CHECK NO:
--------------------------
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.o05(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
$APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, 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 DIRECTLY OR INDIRECTLY
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
NOR LIMIT 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
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 LA CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAT AINS NCE AND RCW 18:27.
DATE SIGNED
SIGNATURE (OWNER AGI�NT):
VARIANCE OR CU
CAH
WAIVER 13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D , PROVIDED
REMARKS
TYPE
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SHORELINE RADB# I INSPECTION SEPA
REQ'D 01 COIJPIET�D I EXEMPT
OYES 13N
ZONE SIGN AREA HEIGHT
OP
ALLOWED I PROPOSED I ALLOWED , PR OSEO
REQUIRED SETBACKS (FT R OSED SETBACKS (FT.)
FRONT SIDE REAR EFROOPNT LIR SIDE REAR
z
1 2
LOT AREA I PLANNING REVIEWED BY DATE 5
IL
OCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REOUIRED 13YES I I LOAD I
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Arnt. Due
Receipt #
APPLICATION APPROVAL
Ties application is not a pornut until signed by the
Building Official or hisftr Deputy and Fees are paid, and
receipt is acknowledged in space provided
(425) T A
771-0220 —RELEASED BY
ATTENTION EXL IJJJ
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
io/04 PRESS HARD - YOU ARE MAKING 4 COPIES
11116"
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...............
Wall ................. .........
Pier/Porch .................
Retaining Wall ...........
z
0
Slab Insulation ..........
0
PLUMBING:
=i 5i
Underground .............
--I
Rough -In ...................
M
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Commercial Final ......
0
—40
0
HEATING:
__4
x IT!
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GasTest ....................
C z
Gas Piping .................
Equipment .................
0 _n
Commercial Final .......
3:9
EXTERIOR SHEATHING
M M
NAILING ..........................
00—)
0
FRAMING ........................
0 171
C Cl)
FIRST FLOOR FRAMING ...
C Cn
IT! 0
Z
INSULATION ...................
Floor Insulation .........
-A
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
—i
0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. z244
The Initials MT are M ilt011
ThortipsOn, a temporary colltrar-t
inspcctor for the City.