20041004.pdfFD ATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER-HAMEiNAME OF BUSINESS I
MAILING ADDK-SS
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CITY
NAME
ADDRESS
ADDRESS
CITY
NSE NUMBER
PROPERTYTAX
NEW
ADDITION
1,21
REMODEL
1:1
REPAIR
1:1
DEMOLISH
GARAGE
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CARPORT
NUMBER
OF
STORIES
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TELEPHONE
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EXPIRATION DATE
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- PARCEL NO
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11 COMMERCIAL
E] MIXED USE
El MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLAIN
ESCRIBE WORK TO BE DONE
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NUMBER OF
DWEI - LING
UNITS I
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
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PERMIT
NUMBER
JOB SUITEtAPT#
ADDRESS Cf
PLAT NAME/S UB DIVISION NO�
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP ApprovLdl
13
13
RW Permil Required
Street use Permit Required
13
EXISTING
inspection Required
13
-PROPOSED
Sidewalk Required
C3
REQUIRED DEDICATION FT
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METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES 13 NOO
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
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WAIVER [3
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
F� SIGN REO'D PROVIDED
FENCE i —
( X FT.) REMARKS
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FIRE SPRINKLER
FIRE ALARM
TYPE
SPECIAL INSPECT161
REQUIRED 13 YES
REMARKS
SHORELINE OR ADB# INSPECTION SEPA
REQ'D cc
113YES 13NOI
Z014E SIGN AREA HEIGHT
I ALLOWED , PROPOSED i ALLOWED , PROPOSED
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR
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LOT AREA I PLANNING REVIEWED BY DATE 5
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CONSULTANT
OCCUPANT
GROUP
OCCUPANT
LOAD
GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
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Description
FEE
Description
FEE
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Plan Check
State Surcharge
HEAT SCTURCE
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LOT SLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Be
Mechanical
-
THIS PERM IT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Fngr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipr#
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
I
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
Landscapelnsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt#__,224/
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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 is not a permit until signed 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 BE EMPLOYED
OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt isacknowledged in space provided
IN VIOLATION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
NAVORE DATE
_,�j , I -
SIG R W G N DATE SIG ED (425)
771-0220 RELEASE
ATTENTION EXT. 1333
IT IS UNLAWFULTO 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.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
In
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER 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 ................... Plav"Lb Rr 4ppr�,,
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 ..................
The Initials wr are Milton
Thompson, a temporary contract
ilispector ror the City.
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