20050109.pdf9
DATE RECEIVfD
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
FR NAM41INoNME OF BUSINESS j
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PERMIT EXPIRES Z
PERMIT
NUMBER
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ADDRESS -/)/) 21) �7 `7,,,� &
Pl. AT NAMEISUBDIVISION NO. I LOT NO
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CITY ?FP TELEPHONE EXISTING __ PROPOSED
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REQUIRED DEDICATION FT
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STATE LICENSE NUMBER
ILTION DATE]
EXPIRATION DATE
CHE,CKED BY
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PROPERTY T�AX ACCOUNT PARCEL NO.
NEW ar RESIDENTIAL n PLUM13ING MECH
COMMERCIAL COMPLIANCE OR
ADDITION
MIXED USjE
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REMODEL OILY
MULTIFAMILY
SIGN
REPAIR GRADING
FENCE
CYOS X FT.)
DEMOLISH TANK
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GARAGE ED RETAINING
WALL FIRE SPRINKLER
CARPORT ROCKERY
(TYPE OF USE, BUSINESS UK A(;] IVI I Y') EXPJ-AK.
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LID NO
LID FEE S
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TESCP Approved
RW Permit Required
Street Use Permit Required
inspection Required
Siau�alk Required
Underground
W611no roquired
PRV REQUIRED
YESO NO CI
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY
DATE
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WAIVER 13 ALLOWED PROPOSED ALLOWED PROPOSED1
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIIDE REAR
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REMARKS
TYPE OF CONSTRUCTION
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VALUATION
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Description FEE
Description FEE
State Surcharge D 6,�
Plan Check
HEAT SOURCE LOT SLOPE% VESTED DATE Building Permit v4zjr� City Surcharge
riptio n
'urcharge
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FEE
Fee
PLAN CHE�C�INQ Plumbing Base
Mechanical
THIS PERMIT AUTHORIZES ONLY T6E 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
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit 2r
1, W
I 'APPLICAN N BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
lirOAGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF I # ZA /74,
ERES Recei L
'MNOT N
ED DS, li�ASHINGTON. ITS OFFICIALS, EMPLOYEES AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
FROM THE ISSU Landscapelnsp. Total Amt. Due /,:III:),
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.'
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 perrinit until signed by the
WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy and Fees are paid, and
THE OWNER. I AGREE TO COMPLY Y. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
TION; AND IN DOING THE WORK AUTHORIZED THEREB FOR INSPECTION
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICII I VUP171 E DATE
BAT 'G (425)
7 t DATE
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JATCR Ej 7 -5 771 -0220 RELEASED BY
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-AfTENTIOW 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- ORIGIN;L - FILE - YELLOW - INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110- PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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MEMO TO: PERr 0 , 7-1 _BU�LDING DIVISION
FROM: FIRE DEPARTMENT DATE—
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RE -INSPECTED OUTSTANDING ISSUE, S - GRANT FINAL PROJECT APPROVAL
Date SignatUre
1:temp:b1dg:f6rnis:ocaprv1 3/25/04
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ........... -4
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Slab Insulation .......... M
PLUMBING:
Underground .............
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Rough -In ................... M 0
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Commercial Final ...... 0
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HEATING: M
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GasTest .................... C z
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GasPiping .................
Equipment .................
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Co.-v;,,-,.;iJaI Final .......
EXTERIOR SHEATHING M M
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NAILING .......................... 0
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FRAMING ........................ Cn
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FIRST FLOOR FRAMING ...
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INSULATION ...................
Floor Insulation ......... 3:
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR 1-7
OCCUPANCY ..................
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