20050054.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
0161 ZE/NAME OF BUSINESS
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MAIL114G ADDRESS
CITY zip TELEPHONE
NAME
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PERMIT EXPIRES
PERMIT
NUMBER
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PLAT NAME/SUB DIVISION NO.
LOT NO.
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LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
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E3
RW Permit Required
Street Use Permit Required
E3
EXISTING PROPOSED
Inspection Required
[3
Sidewalk Requited
13
REQUIRED DEDICATION FT
Underground
Waing required
13
0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESD N013
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REMARKS
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OWNER/CONTRACTO14 RESPONSIBLE FOR EROSION CONTROUDRAINAGE
110
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L GAS PIPE TEST BIAUST BE
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OBSERVED BY CITY INSPECTOR
ENGINEERING REVIE SHALL NOT DATE
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FIRE REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRAT ON DATE CL10KED BY VARIANCE OR CU SHORELINE ORADB11 INSPECTIO
REQ'D COMPLETED EXEMPT
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PROPERTY TAX ACCOUNT PARCE . L NO, T_ CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED I PROPOSED I ALLOWED , PROPOSED
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STUDY [3
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
NEW ESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR 0
COMMERCIAL COMPLIANCE OR z
ADDITION El MIXED USE CHANGE OF USE I — I-- -_ - - - E
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL El MULTIFAMILY SIGN REQ'D PROVIDED
GRADING FENCE �=
REPAIR El CYDS 1:1 X FT.) REMARKS
DEMOLISH El TANK 1:1 OTHER
z EGARAGE RETAINING WALL FIRE SPRINKLER
I CARPORT El ROCKERY 13 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
_'I� TYPE OF 0 STRUCTION CODE OCCUPANT
GROUP
Lu NUMBER NUMBER OF
a OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
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REQUIRED DYES
DESCRIBE WORK TO BE DONE
I REMARKS
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GEOTECH
BY: =618 or L vent connectors required
STRUCTUI
BY: bfilfIffl-burning appliances passing
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6 Description ion FEE
FEE Descript
Plan Check State Surcharge
HEAT SOURCE LOT SLOPE% VESTED DATE
et Building Permit City Surcharge
PLANICHECK NO: Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS,, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Uj
PERMIT LIMIT: SEE ECDC 19.00,005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
U)
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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
a DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW'
mi 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 parnit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building Official or hisihor Deputy: and Foos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided,
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELAT114G TO FOR INSPECTION
WORKMEN'S COMPENSATION URANCE AND RCW 18:27.
OF LS SIGI)ATORE DA E
�(OWNER A EN ATEZ.IGNED. (425)
94 r 'Lo 771-0220 &RELS Y
ION 6/17 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 .................
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Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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Underground .............
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Rough -In .................
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Commercial Final ......
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Gas Test . ....................
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Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING'.., .....................
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FIRST FLOOR FRAIIANG....
-..INSULATION ...................... .
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation ........
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
0045
The initials MT are. Milton
a temporary contract
T110,11Pson,
ilispe tor for th e city.
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