20041027.pdfI
FATE RECEIVED [PERMIT EXPIRES
t"ER�IT
CITY OF EDMONDS NUMBER Z
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
OWNER NAMEINAME OF BUSINESS ADDRESS 5f. -5* �16.' )
(7 1, 6� :5 PLAT NAME i SUBDIVISION NO. LOT NO LID NO
NIAILINGt�DRESS LID FEE $
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EXPIRATION DATE VARIANCE OR CU SHORELINE. OR ADBP INSPI 'ON SEPA
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STATE LICENSE NUMBER CHECKED BY :QD COMPLET D I EXEMPT
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CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION 9 1:1 CHANGE OF USE I I z
E] 20 �SE PARKING LOTAREA PLANNING REVIEWED By DATE
REMODEL MULTIFAMILY SIGN REQ'D i PROVIDED
GRADING FENCE
REPAIR CYDS ( X FT.) REMARKS
El DEMOLISH TANK OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
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REMARKS
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BY:
STRUCTURAL DESIGN
BY:
VALUATION
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% _____7ESTED DATE - Building Permit City Surcharge
HECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
i,- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
CID
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOVEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Y CITY ORDINANCE Landscapelnsp, Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF AN
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION Receipt # wk
Recording Fee i L
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 perrud until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or hisilhor Deputy and Feesate paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space Provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICIALS SJGN�TUR DAT En
SIGNATUR (OWNE�R,0 fGENT)��, DATE SIGNED (425)
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c-, o c-/ -0220 RELEASED BY
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ATTEfINOI N 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- ORIGINAL FILE YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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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 ..................
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