20050094.pdf7 DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION
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REPAIR
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GARAGE
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PERMIT EXPIRES
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PERMIT
NUMBER
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PLAT NAMEISUBDIVISION NO.
LOT NO.
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LID NO.
LID FEE $
RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved 0
EXISTING PROPOSED
AW Permit Required 0
Street Use Permit Required 13
Inspection Required E3
JFPUBLIC
Sidewalk Required 13
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REQUIRED DEDICATION FT
Underground E3
Mind re uired E3
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
YESO N013
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REMARKS
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OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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NEERING REVIEWED BY DATE
F.IRE REVIEWED BY DATE LU
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BY VARIANCE OR CU SHORELINE OR ADB# INSPEC . TION SEPA
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113 YES 13 NOI
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13
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LOT COVERAGE REQUIRED SET13ACKS (FT.) PROPOSED SETBACKS (FT.)
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REO'D I PROVIDE
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OCCUPANT
GROUP
ai NUMBER NUMBER OF / / /4-- f �� 4—r cl-11-i;
co OF DWELLING SPECIAL INSPECT
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0 STORIES UNITS LOAD
0 �� I -_ REQUIRED E3 YES
DESCRIBE WORK TO BE DONE
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VALUATIC'
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge
PLAN CHECK NO:
Plumbing Base Fee
0
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 ICURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
o: PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
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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
Lu 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
Do 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 PROVISION.'
Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OW I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
HE W I AG
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TION; No I DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hisinor Deputy: and Foos are paid, and
IN V ' 4LATIO OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WO KMENIS COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS SIGNATURI DATE
IGNATUR (OWNE T): DATE�IGNED
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771-0220 REl_Ei)$ED BY, DATE
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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 YELLOV/- INSPKTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER GOLD - ASSE SOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS . .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ...........
PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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:Gas Test ..................
Gas Piping .................
Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING,
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NAILING ..........................
FRAMING ........................
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FIRST FLOOR FRAMING...
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INSULATIO N ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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