20050288.pdfCITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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NAME
[PERMIT EXPIRES
PERMIT
NUMBER 0 66 — 017V78
JOB SUITEIAPT#
ADDRESS
FLAT NAMEISUBDIVISION NO. LOT N LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP IESCPApp(uvm 13
RW Pefiful Required 13
Street Use Pontrid Required [3
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ENGINEERING REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIRATION DATE
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SIGN AREA
ALLOWED I PROPOSED
HEIGHT
ALLOWED , PROPIMED
PROPEP,TY TAX T PARCEL NO.
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ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE 1:1 CHANGE OF USE
REMODEL MULTIFAMILY El SIGN
GRADING FENCE
1;t�REPAIR CYDS ( X FT.)
DEMOLISH TANK OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
l CARPORT ROCKERY FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT L/RSIDE REAR
PARKING
REQ'D PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
REMARKS
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE 4CONSTRUCTION
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OCCUPANT,'
GROUP
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NUMBER OF
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SPECIAL INSPECTION
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UNITS
LOAD
REQUIRED 13YES
—6E—SCRIBE WORK TO 13E DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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BY:
VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEATSOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAI&tHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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BE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUI31C
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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. SEPARATE PERMISSION.
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC `19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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Fire Review
Plan Chk. Deposit
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_1 IN INTEREST,. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
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< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
aj DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
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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 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
TION: AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
CALL
Building Official or hisihor Deputy: and Fees are paid, and
IN VIOLATION OF THE LaOR CODE OF THE STATE OF WASHINGTON RELATING TO
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FOR INSPECTION receipt is acknowledged in space provided,
WORKMEN'S COMPENS ANCE AND RCW 18:27.
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OFFI V1,LS SIGNATURE IA[E,
IVLAOU'
SIGNATUR?E( tiiil"C IENi DATE S19NED
(425)
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771 -0220
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BY DAVE
ATTENTIOO/
EXT. 1333
IT IS UNLAWFUti;jo USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPIEECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL - 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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Gas Test ....................
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Gas Piping ...............
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
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Floor Insulation ......
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SHEETROCK 14AILING ...
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SPECIAL'INSPECTION ...
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MISCELLANEOUS ..........
IZINAI APPRMAL FOR