20041029.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAVEINAME OF BUSINESS
MAILING ADDRESS
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CITY— ZIP TELEPHONE I
7EM&IM
ADDRESS
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PERMIT
NUMBER
JOB
ADDRESS�
PLAT INAME/SUBDIVISION NO.
PERMIT EXPIRES
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING __ PROPOSED
OUIRED DEDICATION FT
`_<,E'TER SIZE I LINE SIZE NO� OF FIXTURES
LID NO
LID FEE S
TESCP Approved
RW Permit Required
Street Use Permit Requited
Inspection Requited
Sidewalk RerjuirLd
Un(jfilqruund
Witino required
PRV REQUIRED
YES 13 NO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME &L 12
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ENGINEERING REVIEWED BY DATE
ADDRESS
PLFIRE REVIEWED By DATE Lu
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U tdD B)IF - E OR CU SHORELINE ORADB11 INSPECTION SEPA
STATE LICENSEAUMBER EXPIRATION DATE C REQ'D COMPLETED I EXEMPT
13YES ONO I
CA# ZONE SIGN AREA HEIGHT
POSLO
PROPERTY TAX ACCOUNT PARCEL NO. F r ALLOWED PROPOSED
WAIVER 13 ALLOWED I PRO
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW WESIDENTIAL UMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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COMMERCIAL
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[:] MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE I I
EPAIR CYDS ( X FT.) REMARKS
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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STRU
W NUMBER NUMBER OF OCCUPANT
C) OF DWELLING SPECIAL INSPECTION CONSULTANT LOAD
M STORIES UNITS
0 REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS z%w-
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GEOTECH REPORT
BY: fla�LT`ff 1IN-SPIECTOR
STRUCTURAL DESIGN HALL N01'
BY:
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
g— DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
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SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 119.00.005(A)(5)
W
PERMIT LIMIT. SEE ECDC 19.00.005A)(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
U) ESS THE CITY OF
Lu IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARML
_1 Receipt #
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Total Amt. Due
EQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp.
DEEMED TO MODIFY. WAIVE OR REDUCE ANY R
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee 1 Receipt # 4�/ 11-f
"I'l� _ - I
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 Or This application is not a pernet until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building official or hisiflner Deputyi and Fees are paid, and
TION; AND IN DOING THE WORK A HORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
T'
[ON OF T ABOR IDE �FV E STATE OF WASHINGTON RELATING TO FOR INSPECTION
IN VIOLAT 0 URE DATE
WORKMEN'S CoM N TIONy4?FRANCE ED RCW 18:27. L IGN
Sit to NE DATE SIGNED (425)
771-0220 -RELEASED BY IbAj
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- 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:
0,5
GasTest ....................
P)T_
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
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OCCUPANCY ..................
Tile Initials NIT are Milton
Thompson, a temporary contract
inspector for tile City.
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