20041083.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS
L_ K
PERMIT EXPIRES
PEKMIT
NUMBER
JOB SUITEIAPT0
ADDRESS 7-72�; _PT zlic)
AMEISUBDIVISION NO LOTNO LID NO
MAILING ADDRESS LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Parmil Required
7 -7,,P, Pt- 10 Street the Permit Requited
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Requited
Sidewalk Requifixt
Underground
L4 7 Si
REQUIRED DEDICATION FT IN'Tiflit rfaquand
NAME METER SIZE LINE SIZE NO� OF FIXTURES PRV REQUIRED
I I YESO NO13
ADDRESS
NAME CBL#
ADDRESS
10
CITY ZIP TELEPHONE
I �Wtll)wem? "? 90 E-7 zla�; - _/ -2 5- b q 1-1 Lj_
I STATE LICENSE NUMBER E5PIjRATIONPATE I fH�CK JDY
/7'-O'f Ll 1-14
PROPERTY TAX ACCOUNT PARCEL NO,
a 0 00 (17
NEW RESIDENTIAL
ADDITION COMMERCIAL
MIXED USE
REMODEL MULTIFAMILY
REPAIR El GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR A9;FIlVITY) EXPLAIN
NUMBER NUMt3tzK Ut-
OF DWELLING
STORIES UNITS
DESCRIBW�RK TO BE DONE..,
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HEAT SOURCE I LOT SLOPE%
PLAN CHECK NO:
� —.*N
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
L_J ( X FT.)
M 0�4:5 P, Pj "
FIRE SPRINKLER
FIREALARM
I
L-41 6�_5
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 COMPENSATION INSURANCE AND RCW 18:27.
SIGN WNER 0 AGE�T DATE SIGNED
REMARKS � & 11 ; 11 �' ".. i - 'n ;TO N�Wf_` DKNAGE
OWNERICONTRACTOOM�Pro wtv
OBSEBV'rli i"i C11)" 1114FT F 'U"T 0 R
AFFFIDUffSSHALL �10T
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
CA#
WAIVER 13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D . PROVIDED
SPECIAL INSPECTION
REQUIRED El. YES
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.
Recording Fee
SHORELINE OR ADBI I INSPECTION I SEPA
REQ'D COMPLETED
[3 YES E3 NO
I HEIGHT
ZONE SIGN AREA
I ALLOWED , PROPOSED ALLOWED , PROPOSED
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LIR SIDE REAR
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LOT AREA I PLANNING REVIEWED BY DATE 15
(L
CONSULTANT
CALL
FOR INSPECTION
(425)
771-0220
ATTENT10N I t::A 1. 1,3aa
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 / IBC110 / IRC110-
OCCUPANT
GROUP
LOAD
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICTTION APPROVAL
This application is not a permit until signed by the
Building official or hisihor Deputy and Fees are paid, and
receipt is acknowledged in space provided
MdIAI S SIdNATURE DATE
El
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
D BY
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 ....................
Z'2 Ae3
Gas Piping .................
-2-
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
oor Insu at on .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The Initials MT are Milton
Thompson, a temporary contract
inspector for tile City.
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