20041076.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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NAME
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PERMIT EXPIRES 12-f- )-2
PERMIT
NUMBER
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ADDRESS --2- 17,11 1� AV tt�_ \I,3 SUITEIAPT#
PLAT NAMEiSUBDIVISION NO. LOT NO LID NO,
ILID
FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approvm [3
RW Pefrild Required 11
EXISTING PROPOSED
Stfeet use Pernild Requited 0
inspuclion 13
Requited
Sicla*jlk Requited [3
REQUIRED DEDICATION FT
Undergtound 0
WMFIQ r0aUired 0
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
YES 0 NO[3
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE
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CITY ZIP
TELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE
CHECKEDBY
VARIANCE OR CU
SHORELINE OR ADB11
INSPECTIO
REOID
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SEPA
COMPLETED EXEMPT
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WAIVER [3
STUDY [3
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SIGN AREA
ALLOWED , PROPOSED
HEIGHT
ALLOWED , PROPOSED
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PROPERTY TAX ACCOUNT PARCEL NO,
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NEW '.TWRESIDENTIAL PLUMBING i MECH
ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
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MULTIFAMILY SIGN
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LOT COVERAGE
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LJRSIDE REAR
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PARKING
REO'D PROVIDED
LOT AREA
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I PLANNING REVIEWED BY DATE
REPAIR GRADING FENCE
CYDS ( X FT.)
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REMARKS
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DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
JAJOItIC
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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OCCUPAN
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NUMBER
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NUMBER OF
DWELLING
UNITS
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SPECIAC IrSIPECTION
REQUIRED 0YE
ONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
70
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO-
0
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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13.
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
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'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
De/
Recording Fee
Receipt #
'77S v
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 ClfTHM�BOR CODE OF THE STATE OF WASHINGTON RELATING TO
CALL
FOR INSPECTION
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his1her Deputy and Feesare paid. and
receipt is acknowledged in space Provided
WORKMEN' rRl��SOVONIWSIJRANCE AND RCW 18:27.
(425)
771-0220
F LSSIGNAAT%RE DATE
E N E R_ tA,111E N T):
DATE SIGNED
EASED BY
1 - DATI
ATTENTION E EXT. 1333 &�12_
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 It IBC110 if IRC1110. AIGINAL - FILE - YELLOW - INSPECTOR
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:
GasTest ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... 477
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The Initials MT are Milton,
Thol"PsOn, a ternporary contract
inspector for tile city.
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