20050195.pdfI
IDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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NAME
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NAME
ADDRESS
CITY 121,91" TELEPHONE
PROPERTY TAX ACCOUNT I]iARCEL NO
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
lTYPE OF USE, BUSIN
tArimATION DATE EC�
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RESIDENTIAL
PLUMBING / MECH
COMMERCIAL
COMPLIANCE OR
E] MIXED USE
CHANGE OF USE
13 MULTIFAMILY
SIGN
13 GRADING
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FENCE
CYDS
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OTHER
RETAINING WALL
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FIRE SPRINKLER
ROCKERY
FIREALARM
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Lu NUMBER
OF
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nFRCRIBE WORK 10 BE D3NE
NUMBER OF
DWELLING
UNITS
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PERMIT EXPIRES
PERMIT
NUMBER
JOB SUITE/APTP
ADDRESS z '71
PLAT NAMEISUBDIVIS
Or NO
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREETMAP
TESCPApproved 11
RW Perin't Requileii 0
sifeet use Pef"I't Re quifed 0
0
EXISTING PROPOSED
Inspection Require(I
[3
SOjwalk Requiled
0
REQUIRED DEDICATION FT..-.
Undergiound
Wiling rr'quaed 13
METER SIZE
LINE SIZT
NO OF FIXTURES
PRV REQUIRED
YES [3 NOO
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCE OR CU
SHORELINE OR ADB#
INSPEC 'ON
SEPA
REQID
COMPLETED EXEMPT
13 YES 13NOI
I
CAP
ZONE
SIGN AREA
HEIGHT
WAIVER 13
ALLOWED PROPOSED
1
ALLOWED PROPOSED
STUDY [3
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LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJRSIDE REAR
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PARKING
OTAREA
PLANNING REVIEWED BY DATE
REQ'D I PROVIDEDF
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TYPE OF CONSTRUCTION
L:I"
OCCUPANT
GROUP
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SPE TIO CONSULTANT OCCUPANT
LOAD
REQUIRED 13 YES
REMARKS
2 c)
GEOTECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
1-7 -7
$
GAS PIPE TESI MUS1 BE
Description
SERVED B FrITOR
Plan Check
-0
HEAT �OURCE
I AFFIDAVITS S
TWPTED
VEND E
ALL
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED, THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
Grading
Engr. Review
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SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00-005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
* EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
* ALL CLAIMS FOR UAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
4 ISSUANCE OF THIS PERMIT SHALL NOT BE
x FROM THE ISSUANCE OF THIS PERMIT.
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LI T IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
C �nDRECT* AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
MARSHAL
MUST BE PRESENT
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jTRF7"Uj_ MOW,
GIVEN I
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE S1 �'TE OF WASHINGTON RELATING TO FOR INSPECTION
WORKME)CS CoM'PENSATION IN,SURANCE AND 'V 18:27.
1% - i DATE S1 NED
SIGfif iU IRE��WWNIER 9� A t):
A G
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due <f�
1-TS
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or lus1hor Deputy and Fees are paid. and
receipt is acknowledged in space provided
J_ L tAL IJJa
ATT TION
IT IS U LAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 f IBC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OVONER GOLD - ASSESSOR
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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 ....................
ell,
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING . ........................
FIRST FLOOR FRAMING ...
JNSUL�?N ........
"-insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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