20040965.pdfFDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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MAILING ADDRESS
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NAME
ADDRESS
ADDRESS
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CITY . ZIP
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STATE LICENSE NUMBER
TELEPHONE
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FzERMIT EXPIRES �5
PERMIT
NUMBER
JOB SUITEIAPTts
ADDRESS I e- -- --
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PLAT NAMEISUBDIVISION NO.
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Aprno�ed 0
0
R-N Permit RequirwJ
siteet use Permt Requitea 0
EXISTING PROPOSED
lng�eciion Requitea C3
-
Sidewalk ReqUfflid [3
REQUIRED DEDICATION FT
unowgmurld 0
Wifinq required E3
METER SIZE
NO, OF FIXTURES
PRV REQUIRED
F
YES13 NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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TELEPHONE
EXPIRATION DATE I CHECKED BY'
PROPERTY TAX ACCOUNT PARCEL NO
00 7 7 1-a -
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1:1 NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
OF USE
MIXED USE
CHANGE
REMODEL
MULTIFAMILY
SIGN
E] REPAIR
GRADING
CYDS
FENCE
FT.)
DEMOLISH
TANK
E]
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
Ei
FIRE SPRINKLER
FIRE ALARM
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
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CA# N
WAIVER 13
STUDY 13\
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D , PROVIDED
REMARKS
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0
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
TYPE_PF,4 TRUCTI
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NUMBER NUMBER OF
OF DWELLING
-2,
SPECIAL INSPECTION
STORIES UNITS
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
Plan Check
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
---
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr, Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
14.1
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
in
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
E
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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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.*
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THATI AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMIpr "TH CITY AND STATE LAWS REGULATING CONSTRUC-
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TION: A THORIZED THEREBY, NO PERSON WILL BE EMPLOYED
.�D IN DOING THE WORIr OC
IN TI011f OF THE LABni ODE OF THE STATE OF WASHINGTON RELATING TO
T, SURO
WrI1922M - VAJ SURANCE AND RCW 118:27.
ArrejAIrliagom
DATE
DATE Ui
ce.
U-
SHORELINE ORADB�,fj INSPEC ON I SEPA
REO TDI 0 COMPLETED I EXT
�]'OYES ti( N
4d1.1A 14ri 7
ZONE I SIGN AREA HEIGHT
ALLOWED PROPOSED ALLOWED PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR
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LOTAREA Pr ING RE
�ON
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CODE OCCUPANT
GROUP 9-2-
CONSULTANT OCCUPANT
I LOAD
FEE
'. 2,
Description
FEE_
State Surcharge
City Surcharge
45
Base Fee
pi-�
Plan Chk. Deposit
Receipt # Z �5ZV62
Total Amt. Due
R ipt #
ecei I #
APPLICATION APPROVAL
This application is not a pernlit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided
FtCMrk--52NA14k J DATE
DATE
k
UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUC I URE U14 1 11-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL . FIL YEL A - INSIIECTC
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -tQWNIR GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
RELEAS-
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.4TTENf ION I I r-A 1. 1 aaa . U ,
DATE SIGNED
111)"q'I
CALL
FOR INSPECTION
(425)
771-0220
a
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0
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch ................. 0
Retaining Wall ........... 0
M
Slab Insulation ..........
PLUMBING:
M
C:
Underground ............. M 0
--1 0
0
Rough -In ................... 0 C
Commercial Final ...... X M
M Z
HEATING:
C: z
GasTest ....................
3:
Gas Piping .................
0 -n
Equipment .................
3:9
Commercial Final ....... M M
0
0
EXTERIOR SHEATHING 0 M
NAILING .......................... C cl)
9 Cl)
FRAMING ........................ M C-)
Z
FIRST FLOOR FRAMING ...
INSULATION ................... AL
3:
Floor Insulation ......... z
--I
Wall Insulation ........... :C
z
Ceiling Insulation ....... 0
SHEETROCK NAILING ... F)
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................