20050196.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEiNAME OF BUSINESS 'k
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MAILING ADDRESS
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CITY ZIP TEI�EPHONE
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NAME
TELEPHONE
NAME CBL4
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ADDRESS
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CITY ZIP/7 I TELEPHONE I
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PROPERTYTAX CCOUNTPARCELNO.
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NEW
F IESIDENTIAL
PLUMBING / MECH
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ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
E] GRADING
CYDS
FENCE
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DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIREALARM
[PERMIT EXPIRES
PERMIT
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NUMBER L
JOB SUITEIAPTI$
ADDRESS Z
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PLAT NAME/SUBDIVISION NO. LOT NO LID NO
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 7 ESCP Approved
RW Pound Required
Street use Permit Requited
EXISTING PROPOSED Inspeclion Requiro(l
SjdaAji1K Roquired
REQUIRED DEDICATION FT Unee(ground
wainq roquarid
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YESO NOO
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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VARIANCEORCU I SHORELINE ORADBO I INSREE(C
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OYES 13NOI
CAN ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED I PROPOSED I ALLOWED , PROPOSED
STUDY 13 1
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR C)
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PARKING LOTAREA I PLANNING REVIEWED BY DATE 5
REQ'D PROVIDED IL
FT.) I REMARKS
-OF USE, BUSINESS QF�AQTIVITY XPLAIN:
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OCCUPANT
GROUP
NUMBER -NUMBER OF ___� f 1�111 I '
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
LOAD
STORIES UNITS
REQUIRED 13YES
DESCRIBE WORK TO BE DONE I I
REMARKS
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GAS PIPE TEST M UST BE 5
i�, 5 4c, F GEOTECH REPORT OBSERVED BY 5
BY: AFROAVII a .3 INSPECTOR to
Li r" c% Of I STRUCTURAL DESIGN "HALL NOT
BY: BE ACCE
VALUATION VIED
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Description FEE Description FEE
Z2 Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
PLAN CHECK 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
ILL REQUIRE Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) W
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
u
L PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
r: 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
CITY ORDINANCE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt 4
I HEREBY ACK NOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPRONIAI
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not it perfTlit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL Building Off icial or hisihor 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'S CC�MPENSATION INSURANCE AND RCW 18:27. CFF� �IS SIGNATU DATE
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DATE SIGNED (425)
SIG�A E to W 47ER 6`1�t �G I N T):
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771"0220 RELEASED Ky VATV
ATTZ41ON EXT. 1333
IT IS U AWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
SETBACKS .....................
FOUNDATION,
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile Initials NIT are Milton
Thompson, a temporary contract
inspector for tile City.
INSPECTOR DATE APPROVED
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