20050036.pdf'FCATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
D
MAILING ADDRESS
/-7� <,,too.t-t
CITY ZIP
` i -
a"I I'll 0 Ila. � t/V
NAME
020104321
TELEPHONE
PERMIT EXPIRES '7
PERMIT
NUMBER
JOB SUITE/APTt$
ADDRESS
PLAT NAME/SUBDIVISION NO
LID NO
1!
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprov
RW Permit Required
[3
13
Streel use Permit Required
0
EXISTING PROPOSED
inspection Required
S,d,,j1k Required
REQUIRED DEDICATION——- FT
underground
Wilin W U fed
22
METER SIZE
LINE SIZE
RES
PRV REQUIRED
YES C3 NOE3
C)
Z_
Cr
REMARKS
OWNERiCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
z
5
z
ul
NAME CBL#
9'e vkle.
ENGINEERING REVIEWED BY
DATE
o: ADDRESS
FIRE REVIEWED BY.
DATE
W
CITY ZIP TELEPHONE
a:
0 P
�SEPA
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
VARIANCE OR CU SHORELINE OR ADB# INSPECTION
REO'D COMPLETED EXEMPT
OYES 13NOI HEIGF I IT
CA# ZONE—j
SIGN AREA
4 PROPERTY TAX ACCOUNT PARCEL NO
0
/2.8 3
WAIVER13
ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13
PLk
NEW RESIDENTIAL LUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT LIRSIDE REAR
o`0
'Q/COMMERCIAL NIPLIANCE OR
ADDITION
I
'REQUIRED
I
z
z
z
CHANGE OF USE
/ZEJ MIXED USE
—
PARKING LOTAREA PLANNING REVIEWED BY DATE
OT P
El REMODEL MULTIFAMILY SIGN
REQ'D I PROVIDED
CL
REPAIR GRADING CYDS Ei FENCE x FT)
REMARKS
DEMOLISH TANK 0 OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
El FIREALARM
z CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
9: -
V\+
TYP S R
OCCUPAN
Cff / GROUP
V) L NUMBER NUMBER &
U
0 DWELLING
OF AIIA
!EO
SPECIAL INSePECTION
CONSULTANT OCCUPANT
LOAD
M
0 STORIES UNITS
�U I Y
REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS
z
X,
GEOTECH REPORT
�7
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
Building Permit
City Surcharge 11 pe—,
PLAN CHECK NO:
Plumbing
Base Fee IZI,
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
rz PERMIT APPLICATION: SEE ECDC 19,00.005(A)(5)
W
0. PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
cn
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_1 FROM ANY AND
Receipt ft
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS
Fire Inspection
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
Total Amt. Due
a ODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO M
0 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
APP ION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a In!rnin until signed by Ine
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
Building Official or hisilber Dej)LAy and Fees are paid. aritt
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
OF THE STATE OF WASHINGTON RELATING TO
feceipt isacknowle(iged in spacO Provided
FOR INSPECTION
IN VIOLATION OF THE LABOR CODE
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
Ri E
FfWA IGN T ATE
DATE SIGNED
SIGNATURE (OWNER N
(425)
771-0220
RE AS D BY
RELEASED BY
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. LIBC109 If IBC110 / IRC110.
PINK - OWNER GOLD - ASSESSOR
PRESS HARD - YOU
ARE MAKING 4 COPIES
10104
z
0
1
0
M
—i -n
M
C
M
0
C)
0 C:
j K
a: M
M Z
04
C —Z
X
0 -n
M M
0 _Cn
0 r_
0 M
C Cn
K U)
Q 0
Z
z
—i
X
(1)
z
0
1
0
M
N�
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 ..................
z
0
A
0
M
M
C
M
0
-40
0 C
3: M
M Z
C
3:
0
M M
0
0
0 M
C cl)
9 C/)
ITI 0
Z
3:
>
z
Cl)
z
0
I
0
1711