20041080.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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'5_�_Ce s.
NAME
ADDRESS
NAME
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CITY ZIP TELEPHONE
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17 2616 3,59' �Z 6 5! 3
.STATE LICENSE NUMBER EXPIRATION DATE I CHECKED 13Y
2 h /0 OC9 ? X':7- lor-
TAX ACCOUNT PARCEL NO.
E] NEW I Z RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
El
MULTIFAMILY
REPAIR
GRADING CYOS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR-Af)TIVITY) EXPLAIN
NUMBER
OF
STORIE§�
DESCRIBE
7K5
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HEAT SOURCE
BE DONE
PLAN CHECK NO:
PERMIT
NUMBER
JOB
ADDRESS
PLAT NAMEISUBDIVISION NO.
PERMIT EXPIRES
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE I LINE SIZE NO� OF FIXTURES
SUITEIAPT$;
." _;p Lfl�
LID NO
LID FEE S
TESCPApp,ovod
RW Permit Required
Stietil List, Pound Requited
Inspection Requited
Sidewalk Required
underground
Mono reauited
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
flit U b
NOT
AFFI[JAWTS 11 A'
ENGINEERING REVIEWED BY 'P)K. A �0�jEVJ"L�LO DATE
FIRE REVIEWED BY
VARIANCE OR CU
CAH
WAIVER 13
STUDY [3
IG /
PLUMBING / MECH
LOT COVERAGE
ALLOWED PROPOSED
NCE OR
COMPLIANCE OR
IMECH
CHANGE OF USE
OF US E
PARKING
REQ'D PROVIDED
SIGN
FENCE
I
x FT.)
REMARKS
El OTHER
FIRE SPRINKLER
FIREALARM
NUMBER OF
DWELLING
UNITS
LOTSLOPE%
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
YVORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
SIGN, �DWN t JG7 DATE SIGNED
Lj
SPECIAL INSPECTION
REQUIRED 0 YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DE�IGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
DATE
SHORELINEORADB# INSPECTION SEPA
REO'D COM
C3
YES 13NOI
ZONE __VSIGN AREA HEIGHT
ALL,
ALLOWED . PROPOSED I ALLOWED I PROPOSED
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W
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REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT L/R SIDE REAR LD
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LOTAREA rPLANNING REVIEWED BY DATE
0.
CONSULTANT
CALL
FOR INSPECTION
(425)
771-0220
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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110.
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPR A
This application is not a parrinit until signed by the
Building Official or his/tier Deputy and Fees are paid. and
receipt is acknowledged in space provided
FIQIALS SIG4ATORE DATE
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:
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 ..................
The Initials MT are Milton
Thompson, a temporary contract
inspector for tile City.
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