20041086 (2).pdf0
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PERMIT
CITY OF EDMONDS NUMBER7- - C, C rC-)
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTP
ADDRESS -7
OWNER NAME/NAME OF BUSINESS '? 70
M Irl� PLAT NAME)SUBDIVISION NO LOT NO LID NO
U MAILING ADDRESS LID FEE S
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z TESCPApproved 0
3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 gig Lj,�. RW Permit R"ulrod 13
Street Use Pennit Required E3
CITY ZIP TELEPHONE EXISTING PROPOSED Inspec%on Ruquaed (3
50e*alk Requited 0
REQUIRED DEDICATION FT undergiound 0
waing required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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CITY ZIP TELEPHONE
NAME CBLP
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ENGINEERING REVIEWEDBY
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FIRE REVIEWED BY
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STATE LICENSE NUMBER EXPIRATION DATE CH BY VARIANCE OR CU SHORELINEORADBII 6s0Ccfi6 SEPA
REQ*D COMPLETED EXEMPT
C,"i 9 9 0 F 3-h 13 YES ONO I
PROPERTY TAX ACCOUNT PARCEL NO . ...... CAP ZONE SIGN AREA HEIGHT
< ONO-) WAIVER [3 ALLOWED I PROPOSED ALLOWED PROPOSED
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F�SrRESIDENTIAL fEC LOTCOVER '��ItREB,13 KSJ�fi PROPOSED SETBACKS (FT.)
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COMPLIANCE OR P"F�Tp N�t- 'All 4 Ontlectors require(
El ADDITION CHANGE OF USE e INA& z
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REMODEL PARKING DED h R RE IR�
1:1 MULTIFAMILY SIGN REQ'D I PROVI 3LtzL'ItIcated SPAC-09. WC 803.
FENCE
REPAIR 13 GRADING CYDS ( X FT.) REMARKS
DEMOLISH 13 TANK OTHE . R
z ElGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY FIREALARM
(TYPE OF USE, BUSINESS ORACSJE
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F�TION OCCUPAN
GROUP
w NUMBER NUMBER OF M
0 OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
M UNITS LOAD
0 STORIES 3 QUIRED [3 YES
DESCRIBE WORK TO BE DONE RE
REMARKS
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GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
00 11
I f U $
Description FEE Description FEE
Plan Check State Surcharge
HEATSOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
HECK NO: Plumbing Base Fee
Mechanical
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 Grading
SEPARATE PERMISSION.
2- Engr. Review
n: PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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(L PERMIT LIMIT: SEE ECDC 19.00,005(A)(6) Engr, Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) Plan Chk. Deposit
in 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
LLI
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Y CITY ORDINANCE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF AN 13 5
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a perinit Until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building 01ficial or his1her Deputy and Fees are pimi. and
TION: AND IN DOING THEWORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED fecLipt is aCknowledged in space provided
IN VIOLATION Of_qHE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S rPC�� INSURANCE AND RCW 18:27. O.E.�ALS '319NA (JRE CAT i
S GNATURE WN7EbR AGENT): DATE SIGNED (425) Xikzy
771-0220 -RELEA—SE6 ErY_ DAI E
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- ORIGINAL -FILE - YELLOW -INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 If IRC110. PINK -OWNER - GOLD - ASSESSOR
10/04 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 ...........
-In ...........
Rough .......
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment ................. 3 0 5
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 ..................
Ice&
The 111iti,,lis MT are WWI'
Thol"Pson, a te,,,porary contract
illspector for the City-
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