20041003.pdfV
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
E07E�R �A E/NAME OF, BUSINESS
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MAILING ADDRESS
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NAME
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STATE LICENSE NUMBER
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EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO
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COMMERCIAL
ADDITION
MIXED USE
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MULTIFAMILY
REPAIR
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GRADING CYDS
DEMOLISH
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GARAGE
CARPORT
RETAINING WALL
ROCKERY
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COMPLIANCE OR
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FIRE SPRINKLER
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03 UNITS
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DFSCRIBE WORK TO BE DONE
PERMIT EXPIRES
PERMIT
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NUMBER 21
JOB SUITE/APT#
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ADDRESS —; / --
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PLAT NAMEiSUBDIVISION NO
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LID NO
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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TESCPAPproved 13
RW Perrid Required 13
Street use Permit Requiiecs 0
EXISTING PROPOSED
inspection Required 13
SKjo*alk RoquirN 13
REOUIRED DEDICATION ____ FT
Unaerg(ound 0
Wiring required 13
METER SIZE
LINE SIZE
FIXTURES
PRV REQUIRED
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YES 13 NO13 z
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REMARKS W
WNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE z
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I_ I T _ . . . . � . . - . I . I � I I - .. - - . . . . . . . .
Type 13 C.R. 1, I -ell! -onnectors required
on passing
SpRees. fmc 803.1
FIRE REVIEWED BY
DATE
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VARIANCE OR CU SHORELINE OR ADB9 INSPE.CTION S,EPA
RE D COMPLET E D I EXEMPT
10YES 13NOI
CAft ZONE SIGN AREA HEIGHT
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WAIVER 13 ALLOWED PROPOSED ALLOWED
ft
VARIAN
IV� R 0
E OR
PROPOSED
STUDY 13
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LOT COVFF AGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PR FRONT SIDE REAR FRONT L/RSIDE REAR
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OWED PROPOSED
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PARKING LOT AREA] PLANNING REVIEWED BY DATE
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TYPE
OCCUPANT
GROUP
SPECIh INSPE6TION CONSULTANT OCCUPANT
LOAD
FRPEQUIRED 13 YES I
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HEAT SOURCE I LOT SLOPE% 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
'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,'
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE Description
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPILIUAI 1UN ArrmuVIAL
GIVEN ' IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF Tnis application is riot a perrilil until signed by In(!
T T 0
HE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Building Otficial or hisom Deouly and Feesare paid and
TI 0 -ice Provided
receiril sacknowledged in sp,
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
I I . "'. ,
N VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION _71rj__
in . /I - DATf_
WORKMEN'S COMPENSATION INSURANCE AND RCW 16:27. 1 11 LS SIGNATYJRr
SIGNATURE (OWNER 0 DATE Sit JNED (425)
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771-0220
ATTENTION EXT. 1333
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 if IBC110 / IRC1110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
FEE
ON;
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr Inspection
Fire Review
Fire Inspection
Landscape Insp
Recording Fee
ORIGINAL - FILE YELLOW . INSPEC [OR
PINK -OWNER GOLD � ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
,SETBACKS ............ ........
VOUNDA
Fqqing. ....................... ... .
''Wall ....... : ...............
Pier/Porch .................
Retaining Wall ...........
Stab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
TEquipment ................. 122 1
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 ..................
V040000"
03
The Initials MT are MlIt011
T1101"Ps011, a temporary colitrUct
illspcctor for the CitY.
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