20041052.pdfDATE RECE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE AME/NAME OF 13USINESS
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MAILING ADDRESS
CITY
NAME
ZIP
ZIP
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS4,�)/
PLAT NAMEISUBDIVISION NO LOT NO
PUBLIC RIGHT OF WAY PER OFFICIA1 �TT�t "T MAP
2_� 1
TELEPHONE EXISTING PROPOSED.___.
REQUIRED DEDICATION FT
METER SIZE LINE SIZE T r-7) c�
E
CBL#
ADPE.SS. I lb t) 5
0% In & —
CITY ClQi-Ad,.44 I TELEPHONE
STATE LICENSE NUMBER
=061=41MIM
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
EGARAGE
CARPORT
PARCEL NO.
[]
RESIDENTIAL
COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIVITY) EXPLA
R
u AgLiA411
W NUMBER NUMBER OF
0 OF DWELLING
1:0 UNITS
0 STORIES
�n
DESCRIBE WORK TO BE DONE
121
HEAT SOURCE I LOTSLOPE%
PLAN CHECK NO:
LOMA
11-AIA
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT.)
F� OTHER
EFIRE SPRINKLER
3 FIREALARM
VESTED DATE
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
'APPLICANT, 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 THIS 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSAIIPhQ�SURANCE AND RCW 18:27.
7 TURE (OWNER DATE SIGNED
7. 1 rl r& , A-- )(�, I I zi *. 1)�
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LID NO
LID FEE S
TESCP Appmved
0
kVil Pormil ReQwlfW
0
Sjq,�j u,.fj Perma Rptluitc-d
[3
instwovin Roqutrea
E3
54,1*.11k RfIquirtd
13
Undwormnd
0
0
rf,quaoa
V FIXTURES
PRV REQUIRED
� YES 13 NO[3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED 13Y DATE
VARIANCE OR CU SHORELINE OR ADB11 I INSRPEEQC�ION SEPA
D COMPLETED I EXEMPT
0 YES [3 NOI
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED , PROPOSED I ALLOWED , PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
PARKING LOTAREA PLANNING REVIEWED BY DATE
REO*D , PROVIDED t I
REMARKS
OCCUPANT
GROUP
0
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!�PE(51AL IN'SkCTION CONSULTANT OCCUPANT
REQUIRED I I I LOAD I
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recordina Fee
CALL
FOR INSPECTION
(425)
771-0220
11
FEE
Description FEE
State Surcharge
City Surcharge
Base Fee 1/9
Plan Chk. Deposit
Receipt 1$
of
Total Anit. Due
Receipt #
APPLICATION APPROVAL
This appixation is not a permit until signed by the
Building Otficial or hisleer Deputy and Fees we paid,and
receipt is acknowledged in Npace pfovided
F IALS SIGNATURE DATE
j /
z YVI a 14 /1 1 A/
ATTENTION r—A 1. 1 %3 0
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.
io/04 PRESS HARD - YOU ARE MAKING 4 COPIES
BY
ORIGINAL -FIL.F YELLOW -INSPECTOR
PINK -OWNER G01 D - ASSLSSOR
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117)
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
0
Pier/Porch .................
0
Retaining Wall ...........
ITI
Slab Insulation ..........
PLUMBING:
M
C
Underground .............
M
0
0 0
Rough -In ...................
C
ITI
Commercial Final ......
M z
C) --1
HEATING:
C
>
Gas Test ....................
CD
Gas Piping .................
o -n
Equipment .................
M M
Commercial Final .......
0
EXTERIOR SHEATHING
0 M
C cl)
NAILING ..........................
Cl)
Q 0
FRAMING ........................
Z
A
FIRST FLOOR FRAMING ...
W
INSULATION ....................
x
z
Floor Insulation .........
_11
Wall Insulation ...........
cn
z
Ceiling Insulation .......
0
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SHEETROCK NAILING ...
5
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................