20040992.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
ADDRESS
NAME
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ADDRESS
CITY ZIP FTELEPHONE
LICENSE NUMBER
TAX ACCOUNT PARCEL NO
NEW
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RESIDENTIAL
1:1
COMMERCIAL
ADDITION
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MIXED USE
REMODEL
1:1
MULTIFAMILY
REPAIR
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GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVjjY,4,PejAr
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F�ERMIT EXPIRES
PERMIT
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NUMBER ��coq
JOB < Z!EiAPT#
ADDRESS
6 5
PLAT NAMEISUBDIVISION NO.
LOT NO
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LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
Rw Pigmil Required 0
Stivet LJSu Pound Required E3
0
EXISTING PROPOSED
inspection Required
[3
Sidewalk Required
0
REQUIRED DEDICATION FT
underground
worina required
METER SIZE
LINE SIZE
NO� O� FIXTURES
PRV REQUIRED
YESO NO13 z
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REMARKS
OWNER,,CONTRACTOR RESPONSIBLE FOR EROSION CONTROI /DRAINAGE
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ENGINEERING REVIEWED BY DATE
CHECKED BY
14�7r PLUMBING i IMMM
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COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT.)
OTHER
oFIRE SPRINKLER
FIREALARM
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tr; I NUMBE
W NUMBER ROF
a OF DWELLING
103 UNITS
0 STORIES
DESCRIBE WORK TO BE DONE
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FIRE REVIEWED BY DATE w
VARIANCE OR CU SHORELINE OR AIIIII I INSPECTION SEPA
REQ'D 01 COMPLETED EXIEMPT
13YES 13N I
CA# ZONE SIGN AREA HEIGHT
WAIVERM ALLOWED , PROPOSED ALLOWED , PROPOSED
STUDY
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
REO'D . PROVIDED I I
REMARKS
TYPE �.j qTRUCTION CIE-3 OGCRC0U IPANT
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SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED 0 YES I I LOAD
REMARKS
6, 1:21 GEOTECH REPORT
BY:
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BY: - / <:T"4&&_---
C VALUATION
$ 1� 11 0
Description
Plan Check
HEAT!iCURCE
LOT SLOPE%
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VESTED DATE Building Permit
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PLAN CHECK NO: r�
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Plumbing
0
Mechanical
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
Grading
Engr. Review
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
Engr Inspection
'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 T14E CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEjrf COMPENSATION INSURANCE / AND RCW 18:27.
CALL
FOR INSPECTION
FEE
Description
FEE
State Surcharge
Pe_
City Surcharge
Base Fee
DATE SIGNED (425)
ILL 771-0220 RE
4 1112 #2
Plan Chk. Deposit p ty
Receipt tO
Total Anit. Due
Receipt
APPLICATION APR
This application is not it permit until signed by the
Building Official or his/hur Deputy and Fees are paid.and
receipt is acknowledgLd in space provided
ATTENTION SE OR OVCUPY A BUILDING OR STRUCTURE UNTIL EZA 1.
IT IS UNLAWFUL TO U
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK - O�
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
YELLOW - INSPECIC
GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ................... 4T 7::
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING .......................... 00 /2- 1
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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T11011lPSOIl,',1 tclIlPOl','II*Y collt"(1ct
illspector ror thc City.
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