20040970.pdfDATE RECEIfT 1 .7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
0 L,-S 0 �4
MAILING ADDRESS
7,90F,, J-71"" S).
CITY ZIP TELEPHONE
NAME
TELEPHONE
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[PERMIT EXPIRES
PERMIT V
NUMBER
JOB
ADDRESS*76 oe, SUITE/APTP
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7L`=TN4ME1SUBDIVISION N7 NO, FUl D N C) iiiiiiiiiiirri
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION FT
METER SIZE LINE SIZE NO. OF FIXTURES
TESCP Approved
RW Permit Required
Street use Permit Required
inspection Requited
Siariwalk Required
Underground
Wifinq MqUirrid
PRV REQUIRED
YESM NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS
Ole f.3
FIRE REVIEWED BY DATE
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CITY ZIP
TELEPHONE
e:574-1 C?81 6 6—�
26)6 d.~
VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
REO'D
SEPA
COMPLETED EXEKiPT
STATE LICENSE NUMBER EXPIRATioN_bATE_
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=Y
10YES [3 NO
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CAP
ZONE
SIGN AREA
HEIGHT
PROPERTY TAX ACCOUNT(V�R
WAIVERO
ALLOWED PROPOSED
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ALLOWED PROPOSED
STUDY E3
I
I
NEW >irRESIDENTIAL / MECH
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
L/RSIDE REAR
.>rPLUMBING
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
ADDITION COMMERCIAL COMPLIANCE OR
El
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MIXED USE CHANGE OF USE
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REMODEL El MULTIFAMILY El SIGN
PARKING
REO'D PROVIDED
LOTAREA
PLANNING REVIEWED BY DATE
GRADING FENCE
REPAIR 11 CYDS El ( x FT.)
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REMARKS
DEMOLISH 0 TANK 0 OTHER
DGARAGE RETAINING WALL FIRE SPRINKLER
1:1
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVIT)�� Pt-M
TYfrS OF CONSTRU TION
CODE
OCCUPAN
GROUP
NUMBER
NUMBER OF
SPECIAL INSPECTION
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CONSULTANT
OCCUPANT
OF
DWELLING I
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STORIES I
UNITS
REQUIRED 13 YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
by:
VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
Plumbing I-
PLAN CHECK NO:
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
A Fire Review Plan Chk. Deposit
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
x Recording Fee Receipt H
P
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION TION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Is aPP 11 r a
cal�i is )O� Permit until signed I)y tire
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL h
ullf offi I- is jer
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED d g it �r) DePuly and Fees lie Paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO TION rcPce1c`tL ack owle dqed in %parp provided.
FORINSPEC
WORKMEN'S C?"ENSATION INSURANCE AND RCW 18:27. N
0 CjIAA.S SIG I E
S ATU NERORI��:�.-1 DATE SIGNED (425)
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!EASED
6,7- V 7 X )e
1� A/c 771-0220
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ATT ION EXT. 1333
IT IS LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL -------
rALINSPECTION
A F1 HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -Fit E - YELLOW � INSPFCTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110. PINK -OWNER - GOLD - ASSE9Sorj
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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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:
Underground ............. M
M 0
__10
Rough -in ................... 0
0 C
Commercial Final ...... 3: M
ITI z
HEATING:
M� —0 4- C
Gas Test .................... >
Gas Piping .................
Equipment ................. n
Commercial Final ....... M M
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
C cl)
r. C/)
FRAMING ........................ M 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
>
Floor Insulation ......... z
Wall Insulation ...........
Cn
Ceiling Insulation ....... z
0
SHEETROCK NAILING ... -A
0
ITI
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MT are Milton
Thompson, a temporary contract
inspector foi- tile City.