20040995.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
/ -, � P�j f'., J r— 0 -1-- /ZZ— z_z_C:_
MAILING
CITY ZIP TELEPOONE
2�1
NAME
ADDRESS
NAME
9!5�0r_s -c- 70
ADDRESS
�j
CITY TELEPHONE
ZIP
io) o 7 2-
FWA
CBL41
STATE LICENSE NUMBER EXPIRA;T�CN DATE CHECKED BY
4
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
PLUMBING I MECH
<1
ADDITION
COMMERCIAL
MIXED USE
F�
(COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
E]
GRADING
CYDS
FL:NL;t:
( X FT.)
DEMOLISH
TANK
El
OTHER
m
GARAGE
CARPORT
El
RETAINING WALL
ROCKERY
11
FIRE SPRINKLER
FIREALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
NUMBEFk NUMBER OF
OF DWELLING 12
STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I LOTSLOPE% I VESTED DATE
PLAN CHECK NO:
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
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprovea
RW PernA Required
Street Use Permit Requaed
EXISTING
PROPOSED
Inspeclion Required
Sklewaik Required
REQUIRED DEDICATION
FT
unLie(ground
Wiring equiled
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YESO NOO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
0
z
FE
Lu
11i
z
0
z
W
LU
0:
I—L
A
V
0
V A
ARIANCE OR CU SHORELINE OR ADB# I INSPEOTION SEPA
R D COMPLETED I EXEMPT
[3 YES 13NOI
CA# ZONE SIGN AREA 1 HEIGHT
WAIVER I ALLOWED , PROPOSE ALLOWED I PROPOSED
AIVI 13
S T
TUDY 13
U
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
L 0
ALLOWED PR POSED FRONT SIDE REAR FRONT L/R SIDE REAR
L
z
2
z
PARKING LOT AREA I PLANNING REVIEWED BY DATE
IL
REQ'D . PROVIDED
REMARKS
TYPE OF CONSTRUCTION
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
CODE
CONSULTANT
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
Description
State Surcharge
City Surcharge
Base Fee
M
FEE
PlanChk.Deposit ,')I —
Receipt # 5��-111 7
Total Anit. Due
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 This application 15 not a I)LIM111 Until signLd by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or his1her Deputy and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED receipt is acknowledged in space provided
F 0 RMAT'ON
, AGENT 0 F
C a N ST R U C *
E M P Y]
Lo ED
IN VIOLATION OF T HF-LABC_R CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSA,14014 INS RANCE AND RCW 1817. OFFICIALS SIGNATURE DATE
DATE SIGNED (425)
SIGNATURE (04NER-av;�!�
r�ATE
77
1-0220 REL A, -D BY
EXT. 1333
----ATTENTION------
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- 0131GINAL - FILE YELLOW -INSPEC_4R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
OAPPLICANT, 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.'
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
0
z
z
0
1
0
M
--i -n
(n
0 M
C
M 0
0
C-)
0 C:
M
M Z
01
C
2:
(j)
0 _n
Ti X
>
M M
0 6)
0 r-
0 M
M 0
Z r-
X
z
Cl)
z
0
M
I
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 ....
Gas Piping .................
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 ..................
eo0e
z
0
1
0
ITI
ITI
C
M 0
0
0
0 C:
M
ITI z
o -n
n
M M
0
0
0 M
C cl)
9 Cn
ITI C.)
Z
>
z
:C
CD
z
0
0
ITI