20050219.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEINAME OF BUSINESS I I
CI . TY ZIP IT LEPHONE
NAME
ADDRESS
CITY ZIP TELEPHONE
NAME
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ADDRESS
CITY ZIP TELEPHONE
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SYATtILtCENSE NUMBER ATE C HECKED BY
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�ROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
COMMERCIAL
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ADDII'ION
MIXED USE
REMODEL
E] MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPL IN.
COMPLIANCE OR
CHANGE OF USE
SIGN
mFENCE
I X
F1
OTHER
FIRE SPRINKLER
FIRE ALARM
NUMBER NUMBER OF
OF DWELLING
UNITS
STORIES
nF';CRIBE WORK TO HE DONE
PERMIT EXPIRES
PERMIT
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PLAT NAME)SUBDIV I SION NO.
LOT NO
LID NO
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TLSCPAppro�ed
RW Perinit Requireil
Street Use Permit Required
EXISTING PROPOSED
Inspection Reitutred
SKlowalk RequtfeJ
REQUIRED DEDICATION
FT
UnuotgrounrS
Wirinq requ red
METER SIZE
LINE SIZE
NO� OF FIXTURES
PRV REQUIRED
YES NO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAIMAGE
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ENGINEERING REVIEWED BY DATE
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VAJANCE OR CU/ SHVILINE OR ADBO INSPECTION SEPA
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WAIVER ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
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PARKING I LOTAREA PLANNING REVIEWED BY DATE -3
REO'D I PROVIDED
FT.) I REMARKS
STRUCTION
SPECIAL INSPECTION
REQUIRED 13YES
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GEOTECH REPORT
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Plan Check
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VESTED DATE
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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
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
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscape Insp.
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
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
"cu IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUT14ORIZED AGENT OF
CONSULTANT
Ul
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 STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSAT?11-TURANCE AND RCW 18;27.
SIGNAIUBE (OWNER OkA r) DATE SIGNED (425)
�-AFI y
771-0220
FEE
OCCUPANT
GROUP �
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LOAD
Description
State Surcharge
City Surcharge
Base Fee
FEE
0 1 1
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Plan Chk. Deposit
Receipt #
Total Anit. Due
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Receipt # 4�C�L3 �1.
APPLICATION APPROVAL
This appiwation is not a portnit until signed by the
Building otticial or tusiher Deputy and Foesare paid. and
receipt isacKnowledged in space provided
SIGN URE DATE
J�b)ATE
RELEASED BY
[:A 1. 1 aaa
ATTENTION STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR L—Le _/4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL �-_nt_E YFt LOW -INSPECTOR
I,
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK - 0 NER COLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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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:
GasTest ....................
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 ..................
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