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[PERMIT
EXPIRES
CITY
OF EDMONDS
PERMIT
NUMBER
CONSTRUCTION PERMIT APPLICATION
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PLAT NAM EISUBDIVI SION NO.
LOT NO, LID NO
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP T E SCP Approved
RW Permit Required
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EXISTING PROPOSED
street ustj Permit Requited
Inspection Required
Sidewalk Required
Underground
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METER SIZE LINE SIZE
NO. OF FIXTURES PRV REQUIRED
YES 13 NOM
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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EXPIRATION DATE CKEDBY VARIANCE OR CU SHORELINEORADBO I INSPECTION SEPA
1 1 13 LIFTED I EXEMPT
STATE LICENSE NUMBER —7 REO D COMP
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j PROPERTY TAX ACCOUNT PARCEL NO. ROPOSED WED PROPOSED
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NEW RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
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ITION COMMER61AL COMPLIANCE OR z
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PARKING TAREA PLANNING REVIEWED BY DATE
13 REMODEL El MULTIFAMILY El SIGN REQ'D I PROVIDYED
1:1 REPAIR 0 GRADING CYDS FENCE X FT1 REMARKS
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RETAINING WALL "ER
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(TYPE OF USE, :gSINES-IORACTIJITY) EXPLAIN:
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' OF DWELLING SPE&Z INSPEITION CONSULTANT
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DESCRIBE WORK TO BEbONE
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LA Iiiii /2O_N-%NP GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Descripti I on FEE Description FEE
Plan Check State Surcharge
ESTED DATE
HEATSOURCE LOTSLOPE% Building Permit City Surcharge a
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PLAN CHECK NO: T__ Plumbing r) Base Fee
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Mechanical ?
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO RISr
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
9 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
_j SEPARATE PERMISSION.
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2 Engr. Review
x PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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0. PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
0111 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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u) IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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M 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THECITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION..
X1 Reco I rding Fee Receipt # I*
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 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees 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 RELATING TO FOR INSPECTION
WORKMEN'��h NSATION INSURANCE AND RCW 18:27.
,_J_!� F SIGNIARE DATE
SIGNATU WNER DATE Gi (425)
R D Y DATt
D Y
771-0220 R ft�pj
EXT. 1333
ATTENTION
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 INSP66TOR
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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ENGINEERING INFORMATION STEP FOOTINGS Y/N?
DRIVEWAY SLOPE % GRADING CYDS EASEMENTS
EXISTI NG IMPERVIOUS AREA CONSTRUCTED BEFORE 1977 SQ.FT
EXISTING IMPERVIOUS AREA INSTALLED 1977 OR LATER SQ.FT.
PROPOSED NEW NET IMPERVIOUS SURFACE SQ.FT.
SIDEWALK REQ'D 0 YES [] NO . DRAINAGE PLAN REQ'D [—] YES n NO LID#
UNDERGROUND WIRING REQ-D [:] YES [:] NO STREET DEDICATION FT.
STATE HYDRAULICS PERMIT YES NO PLAT REQUIREMENTS YES NO EUC YES NO
STAFF COMMENTS:
BUILDING CONSTRUCTION INFORMATION
CODE EDITIONS 2003 IBC, IRC, IMC, IFGC, UPC, WSEC, VIAQ WITH AMENDMEN TS
DESIGN CRITERIA WIND EXPOSURE B WIND SPEED 85 MPH SEISMIC ZONE D2
NUMBER OF STORIES BASEMENTS FLOOD ZONE LOT SLOPE %
SOILS REPORT PROVIDEDE] YESE] NO STRUCTURAL CALCS PROVIDED [] YES [] NO
FLOOR AREA (Measured to face of exterior wall)
Existing Proposed Total
Living Space
Garage
Carport
Deck1g_9y,.ED=b
Other
WSECNIAQ,
FuelType Heating System
Ceiling Insulation Window U-Value
Wall Insulation Skylight U-Value
Floor Insulation Glazing %
Door U-Value Slab Insulation
Energy:. ElPrescriptive Option Target
Whole House Ventilation 3�stem Req'd 0 Yes No
Any request for modification, variance or other administrative deviation (herinafter "variance") must be specifically called out and
identified. Approval of any plat or plan containing provisions which do not comply with the city code and for which a variance has
not been specifically identified, requested and considered by the appropriate city offical in accordance with the appropriate
provision'of city code or state law does not approve any items not to code specification.
PERMIT ISSUANCE A PPROVALS
PERM IT # C49-
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DATE
NDITIONS'.OF APPROVAL:
�EN NG. REVIEW &APPROVAL
DATE
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REVIEW &,, APPROV
DATE
�CONDITIONS -OF APPROVAL
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall....................
Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
PLUMB ING:
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Underground .............
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Rough -in ....... ...........
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Commercial.Fin.al ......
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HEATING:
Test
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Gas Piping .................
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 FRAMING...
INSULATION ...................
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
OCCUPANCY ..................
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