20041034.pdfI
DATF RECEiVfD
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
_R NAKIEiNAME OF BUSINESS
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ADDRESS
ZIP
ADDRESS
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CITY ZIP I TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
f,.L.RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
F�
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS 9RACIIVITY) EXPLAIN
RM
PERMIT
NUMBER
JOB
ADDRESS
PLAT NAME SUBDIVISION NO
PERMIT EXPIRES
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LOt NO
dPUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING
AREQUIRED DEDICATION.---- FT
METER SIZE I LINE SIZE NO OF FIX1 URES
CHECKED BY
,Pex�LUMBING / MECH
COMPLIANCE OR
ED CHANGE OF USE
SIGN
F FENCE
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OTHER
FIRE SPRINKLER
FIRE ALARM
SUITE,APT91
L ID NO
t.ir) FEE S
TE.SCP Appo.tsi
RA Perma HNjwroo
.qreel kj%e Perno Req�aed
Insre'(11,111 Hoquaod
54,-Adik Required
Under,
.4iou,d
,Vaoll re'lu'led
PRV REQUIRED
YES [3 NO C]
REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENG
FIRE REVIEWED BY
DATE
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VARIANCE OR CU SHORELINE RAD131 I INSPECTIO SEPA
REO'D COMPLETED EXEMPT
13YES 13 NOI I
CA# ZONE SIGN AREA HEIGH
WAIVERO ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT.) I PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ'D . PROVIDED I I IL
FT.) I REMARKS
NUMBER NUMBER OF
OF DWELLING
STORIES c7l__ 1 UNITS
DESCRIBE WORK TO BE DONE
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HEAT SOURCE LOT SLbrE% VESTED DAdTE
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
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 T141S 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. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V104ATION OP/THE LABPk CODE OF THI� " TATf OF WASHINGTON RELATING TO
11 SW 1 :27.
WORKWWN'S COPEASAPdN INSURA1.iCEAN91XC I
S I 7GkT MUN E R "AG T): DATE NED lo A
L /
I iq'T
OCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OCCL
REQUIRED 13YES I I LOAD
REMARKS
GEOTECH REP' 41n addition to the required
BY:
STRUCTURAL I F=r-IL
BY: pTessurelrelief valveg an app
VALUATION: hSted lipipansion tank shall
$ installOd on all hut wate, t2I
Descriptida-_4_ PlItte
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk, Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt #
CALL
FOR INSPECTION
(425)
771-0220
APPLICATION APPROVAL
This application is not aparmit until signed by the
Building ONicial or his1her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
OF LS SI&GNqUPE DATE
E DBY
ATTLtMON EXT. 133.3,_�
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 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
'SETBACKS .....................
-FOUNDATION*
Footing ......................
Wall ..........................
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0
Pier/Porch .................
0
Retaining Wall ...........
Slab Insulation ...........
C/)
PLUMBING:
M
C
M
Underground .............
0
0
Rough -in ................... 0 C
M
Commercial Final ...... M z
HEATING: C z
Gas Test ......
..............
Gas Piping ................. 0 _n
-n
Equipment ................. x
M ITI
Commercial Final � ......
Cn
0—
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EXTERIOR SHEATHING 0 M
C C0
NAILING .......................... K Cn
M 0
z
FRAMING .............. .........
FIRST FLOOR FRAMING ... ;U
--I
INSULATION ............ ; ........
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Floor Insulation .........
3:
Wall Insulation ...........
z
Ceiling Insulation ....... 0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................