20040983.pdfDATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
918"'o-ntol-las
NAME
ADDRESS
PHONE
PERMIT
NUMBER
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ADDRESS
PLAT NAMEISUBDIVISION NO,
PERMIT EXPIRES, L2Li:�_Q_V
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SUITE/Al�ft
LOT NO, LID NO
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP P1
RVV Permit Required
Street use Pernin Requited
EXISTING PROPOSED Inspection Requited
Sidewalk Required
Undeiground
REQUIRED DEDICATION FT waing required
METER SIZE LINE SIZE NO, CF FIXTURES PRV REQUIRED
I YES 13 NO
REMARKS
OWN ERIC ONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY TELEPHONE 9:
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t --- — — I j VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATION DATEV I C EC REO'D COMPLETED EXEMPT
6 t�'L R G 4 A I L I �) alg�5)hl I 13YES I I
PROPERTY TAX ACCOUNT PARCEL NO. CAIII ZONE SIGN AREA HEIGH
WAIVER13 ALLOWED I PROPOSED ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT-) PROPOSED SETBACKS (FT.)
NEW WESIDENTIAL LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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ADDITION COMMERCIAL F�`COMPLIANCE OR I E
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MIXED USE 5
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EMODEL MULTIFAMILY SIGN REQ'D I PROVIDE�
P GRADING FENCE
REPAIR El CYDS ( X FT.) REMAR _ KS
DEMOLISH E] TANK OTHER
GARAGE o RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TylqE F CONSJI�UCTION QOD9 OCCUPAN
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0 OF DWELLING SPECIAL INSPECTION CONSULTANT
M UNITS REQUIRED 13YES LOAD
0 STORIES
DESCRIBE WORK TO BE DONE
REMARKS
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BY:
STRUCTURAL DESIGN
BY:
C/" VALUATION
C)F— $
Description FEE Description FEE
HEAT SOURCE� LOT SLOPE% VESTED DATE Plan Check State Surcharge
IBuilding Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
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)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Plan Chk. Deposit
(A *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
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x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
o DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- j
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF T hit appi cation is not a permit until signed by the
TE LAWS REGULATING CONSTRUC- UI� Hic: - and Fees are paid, and
THE OWNER. I AGREE TO COMPLY WITH CITY AND STA CALL '�B at or hisihor Deputy
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED r
r eipt is acknowledged in space provided
OF y9E LABOR C.OE OF THE STATE OF WASHINGTON I
IN VIOLATION RELATING TO FOR INSPECTION L�41
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WORKMEN'S 0 ION IN& ANCE AND W 18:27.
GIATURE DATE
DATE SIGNED 2
R 9A AnWf* (425)
IGNATrORE
771 0220 R L D BY DATE
ATT&WON�-'__� EXT. 1333 ------
ITIS UNLAWFULTO USE OROCCUPYA BUILDING OR STRUCTURE UNTIL ----
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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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 ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile Initials MT are Milton
Thompson, a temporary contract
inspector for the City.
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