20040984.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
L" MAILING ADDRESS
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0.
CITY ZIP TELEPHONE
NAME
ADDRESS
NAME
ADDRESS
1(06114 13
CITY
L'Wilij tv woo
STATE LICENSE NUMBER
CBL#
PERMIT EXPIRES
PERMIT
NUMBER
aLv
JOB
SUITE1APT$1
7 ADDRESS
FLAT NAME)SUBDIVISION NO.
LOT NO
LID NO
I
LID FEE S
FUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Appraved
13
0
RW Permil Requirod
Streel Uso Peniiii Requiled
13
EXISTING PROPOSED
Inspeclion Requiled
13
Sidewalk Requifea
REQUIRED DEDICATION FT
unciergiouna
Wirinq nequaLcl
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YESE3 No 0
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL)DRAINAGE
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1W
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
ZIP TELEPHONE
EXPIRATION DATE RCU
I ii Y VARIANCE 0
nAltilo-Ta-f e aisel A)
PROPE5TY TAX ACCOUNT PARCEL NO.
005.,7
-
01000
/ 0,C7
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
El
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FTYPE OF USE, BUSINESS OR ACTIVITyI.E�fTIAIN
U
Lu NUMBER NUMBER OF
0 OF DWELLING
0 STORIES UNITS
DESCRIBE WORK T BE DONE
0
a
HEAT SOURCE I LOTSLOPE%
PLAN CHECK NO:
Rd
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X
OTHER
FIRE SPRINKLER
FIREALARM
*To
VESTED DATE
CA#
WAIVERI13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D . PROVIDED
FT.) I REMARKS
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�005(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 T14E 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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENsATIO
,��E AND RCW 18:27.
SIGNATURE DATE SIGNED
,�INER OR
X7Vq!<X1 Ove q
REQUIRED 13YES
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
Recordinci Fee
DATE
DATE
SHORELINEORADB# INSPECTION SEPA
REO'D COMPLETED I EXEMPT
L4[3YEs_[3NOI
ZONE SIGN AREA HEIGHT
A AL
LLOWED . PROPOSED ALLOWED . PROPOSED
W
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT-)
FRONT SIDE REAR FRONT UR SIDE REAR
z
z
LOT AREA I PLANNING REVIEWED BY DATE
CONSUL
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION tA L I JJJ
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.
OCCUPANT
GROUP
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt # i p:3 I
APPLICATION AP �RFVAL
This appication is not a perwit until signed by the
Building official or his/her Deputy and Fees are paid, and
receipt is acknowledged in space provided
OFFICIALS SIGNATU)RE DATE
17—
/; X
RELEASED BY
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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0
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11
0
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I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ........... z
0
Slab Insulation .......... 0
M
PLUMBING:
Underground .............
3:
Rough -In ................... 1711
C
M
Commercial Final ...... 0
--q 0
0 C
HEATING: K
M
Gas Test .................... M Z
C z
Gas Piping ................. >
3:
Equipment ................. 4127
C0
0 -n
Commercial Final ....... n
EXTERIOR SHEATHING 3:9
M 1711
NAILING ..........................
FRAMING ........................ 0
0 M
C C/)
FIRST FLOOR FRAMING ...
M 0
Z
INSULATION ...................
Floor Insulation ......... ;U
Wall Insulation ........... >
z
Ceiling Insulation ....... --I
:C
C/)
SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION ... --I
0
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0
The Initials MT are Milton
Thompson, a temporary contract
inspector fbr the City.
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