20041039.pdfDATE JECE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
NAME
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ADDRESS
CITY ZIP
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STATE LICENSE NUMBER
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PROPERTY TAX ACCOUtIT �RCEL NO.
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ADDITION
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El MIXED USE
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MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EV4-AIN
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PERMIT EXPIRES
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PLAT NAMEISUBDIVISION
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LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApPro�ed
RW Permit R-quiled
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0
EXISTING.—
PROPOSED
Street use Permit Required
inspection Required
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Sioe,&alk Required
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REQUIRED DEDICATION FT
Underground
Wiring it quired
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METER SIZE
LINE SIZE
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NO OF FIXTURES
PRV REQUIRED
YES ID NO 13
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1�FLUMBING MEC
COMPLIANC5
1:1 CHANGE OF USE
SIGN
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OTHER
FIRE SPRINKLER
FIREALARM
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLJDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHOREL114E OR ADB# I INSPEEQTION SEPA
R D COMPLETE
C3YES 13 NOI
IGHT
L vent COMMeagir rAW 4 1 PROPOSED
PARKING
REO'D , PROVIDED
FT) I REMARKS
LOT AREA I PLANNING REVIEWED BY
NUMBER NUMBER OF I I & 11�% 11 - —
OF DWELLING SPECIAL INSPECTIO CONSULTANT
0 STORIES UNITS
REQUIRED 13YES
DESCRIBE WORK TO BE DONE REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
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OCCUPANT
GRO
OCCUPANT
LOAD
FEE
(/P AIM MIVE2Z Description FEE Description
Plan Check State Surcharge
HEAT �O� LOTSLOPE% TED DATE
CS 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 Grading
IVEWAYS, MARQUEES, ETC.) WILL REQUIRE
DONMAIN (CURBS, SIDEWALKS, DR
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
u
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
n Fire Review Plan Chk. Deposit
n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
U
A IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
F EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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D NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt # g596q
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 Otficial or hisiflier Deputy: and Fees aro 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 C��PENSATION INSURANCE AND RCW 18:27, O�EJCJAI SIGj1T11E LT
12
NERC
r ')R AGENT): DATE SIGNE1 (425)
SIGNATURE IbIN
771"0220 RELEASED BY' DATET
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 ...........
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Slab Insulation .......... 0
PLUMBING: ITI
Underground .............
Rough -In. ......... ;� .......
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Commercial Fin"a'l 0
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0
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HEATING*., 0
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Gas Test .................... M Z
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Gas Piping .................
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Equipment.................
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Commercial Final .......
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EXTERIOR SHEATHING
NAILING..........................
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FRAMING ........................ 0
0 171
FIRST FLOOR FRAMING ... C C/)
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Q 0
INSULATION ................... Z
Floor Insulation ......... ;U
Wall Insulation ...........
Ceiling Insulation ....... z
SHEETROCK NAILING ...
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SPECIAL INSPECTION ... 0
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MT are Milton
Thompson, a temporary contract
inspector for the CitY.
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