20041064.pdf"[DATE RECEIVED
0
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAM&NAME OF BUSINESS
4
MAILING ADDRES S,
CITY ZIP TELEPHONE
NAME
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ADDRESS
NAME
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CITY
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STATE LICENSE NUMBER
ZIP TELEPHONE
010
EXPIRATI DATE
C? w 72,
PARCEL NO
[:] NEW RESIDENTIAL
0 ADDITION COMMERCIAL
MIXED USE
REMODEL MULTIFAMILY
REPAIR GRADING
CYDS
DEMOLISH E] TANK
GARAGE RETAINING WALL
CARPORT
ROCKERY
P
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
LU
a
NUMBER
NUMBER OF
OF
DWELLING
01
STORIES
UNITS
FDESC-RI13E WORK TO BE DONE
PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITEIAPT#
ADDRESS
PLAT NAMEISUBDIVISION NO.
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit RPQLIfQd
EXIST114G PROPOSED
Street Use Permit Required
Inspection Required
Sidewalk Required
REQUIRED DEDICATION FT
Unaergrouno
Wii mg required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I I
YESO NOO
REMARKS
OWNER/qf�TRACTOIR RESPONSIBLE FOR TROSION CONTROUDIRAINAGE
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1-7 1 ENGIN ERING REVIEWED BY
pt� LUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
EFENCE
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M OTHER
FIRE SPRINKLER
FIREALARM
FIRE REVIEWED BY
DATE
DATE
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VARIANCE OR CU SHORELINE RADBP I INSPECTIO SEPA
REO'D COMPLETED I EXEMPT
OYES 13NOI
CA# ZONE SIGN AREA HE IGHT
WAIVER (3 ALLOWED , PROPOSED I ALLOVVrD PROPOSED
STUDY [3 1 1
LOT COVERAGE REQUIRED SETBACKS (FT) [_i��SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR R SIDE REAR C)
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OCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIRED 1:1 YES I I LOAD
GEOTECH REPORT/-2-
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STRUCTURAL DESIGN
BY:
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VALUATION
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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 COVEIRS-WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Grading
Engr. Review
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
Engr. Inspection
'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.*
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
Recording Fee
Receipt # 10��c2i2l
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 COMPENSATION INSURANCE AND RCW 111:27.
CALL
%F INSPEOTION
5
APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Official or hisiher Deputy and Fees are paid, and
rectlipt is acknowledged in space provided
ilrfi,lf�LS SIGN�SURE DA E
�,7 A A �7
SIGNATYR"WNER 0 AG 7)
DATE SIGNED
_401 77 220
REL A I
t
ATTENTION EXT. 1 3 -
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
�X
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / 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 ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ........
PLUMBING:
YVNS
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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