20050304.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OW!�p NAMEINAME OF BUSINESS
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MAILINGADDRESS
CITY
NAME
ADDRESS
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ADDRESS
CITY
STATE LICENSE N
PROPERTY TAX A
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GRADING CYDS
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PERMIT EXPIRES 6
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PERMIT
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NUMBER
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JOB L ,,SUITE/APT#
ADDRESS 71
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PLAT NAIviE1SU BD!VI SION NO,
LOT NO
LID NO
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LID FEE S
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved C3
RW Permit Required E3
EXISTING
PROPOSED
Street Use Permit Required
Instriuclion Required
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Sidewalk Required
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REQUIRED DEDICATION FT
Underground .
Wiling required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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REMARKS
OWNERICONTRAC TOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWI D
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REQUIRED SETBACKS (FT.)
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PROPOSED SETBACKS(FT.)
FRONT LJR-SIDE REAR
COMPLIANCE OR
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PLANNING RE IEWED BY DAT7
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FIRE ALARM
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(TYPE OF USE, BUSINESS OR ACTIVITY) EX IN:
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NUMBER
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NUMBER OF
DWELLING
UNITS
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SPECIAL INSPECTION
REQUIRED 13YES
DESCRI13E WORK Td BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
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Description
Plan Check
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
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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 SUCCESSOR S
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
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 L BOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
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WORKMEN'S inT AID 1'4 1 N S U�X N C E 'A�p R C W,!�: 2y
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SIGNATU WN R AGI*7N, (425)
771-0220
DATE SIG
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For UIMIPIIII�T
.I�QDE OCCUPANT
GROI
jLTANT e—PIZe- OCCUPANT
LOAD
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FEE
Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit '3617.
Receipt #
Total Amt. Due 35-
---T—Receipt 0 r &�
APPLICATION APPR ML
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acktriqwledged in spice provided
"E N T 10 N EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILd/1NG 01�STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 / IRC110-
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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-OWNER GOLD - ASSESSOR
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....................... GARY HAAKENSON
CITY OF EDMONDS MAYOR
121 5TH AVENUE NORTH EDMONDS. WA 98026 (425) 771-0220 FAX (425) 771-0221
Website: www.d.edmondsma.us
DEVELOPMENT SERVICES DEPARTMENT
Planning Building Engineering
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August 10"', 2005
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Frederick West
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94 t 2 l7th Ave NE
Seattle, WA 98115
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RE: Peni -iits numbered 2005-0303 (Cat -port & D/W) and 2005-0304 (Shed)�
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Dear Frederick West:
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.1 am writing as a follow up to my telephone call on 8/19/05. The permits listed above
were issued under the 1997 Unifo rm Building Code which requires an inspection within
the first 180 days (6 months) from permit issuance. If ail inspection is not perfoi -med
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during the first 180 days the permit is considered abandoned. Please call for an
inspection on each of the above listed permits BEFORE October 21 9005 in order to
maintain the validity of your permits.
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Please be advised, if you fail to complete at least, one inspection for each permit prior to
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St the current
October 21 , 2005 your permit will expire by limitation and new plans Linder
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tritemational Building Code, new plan review fees and new permit fees will be required.
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Ifyou have any questio ns please don't hesitate to contact me at 425-771-0220.
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Sincerely;
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Theresa Urnbaugh
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Permit Coordinator
Incorporated August 11, 1890
Sister Citv - Hekinan, Japan
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City of Edmonds 4) A
Plan Review Corrections
Plan Check # Date
Project Name/Address (,IVi� 7- 1*1m ac le
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Contact Person/Address /t- Ic-X146lVe
Public Works
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Submit 2 sets of revised plans/documents to the Permit Coordinator.
Corrections may be made by red lining. plans/documents on rile with the City.
DATEFAXED (Attach fax transmittal) PAGE OF
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FINAL PROJECT APPROVAL FORM
TO:
DATE:
MEMOTO: PERMIT COORDINATOR, BUILDING DIVISION
TROM: DEPARTMENT DATE
—FIRE
PLEASE SIGN
ENGINEERING DIVISION DATE
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PLANNING DIVISION DATE
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PERMIT #2 JZ- IQ 4 AD"B# DATE INSPECTED -
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"DESCRIPTION OF WORK TO BE INSPECTED
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A, field inspecti n was condukted .'to determine wrnpliance with approved'. plans.;, app�oval
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denotes that L� there. are no objections,from the above signed Department �:,tolr. th'' of
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-GRANT PROJECT APPROVAL WITH CONDITIONS NOTED
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Copy of CONDITIONS. given to owner/contractor by inspector
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TAILED FINAL INSPECTION OUTSTANDING ISSUES
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,,,'Copy of CORRECTION NOTICE given to owner/contract tbyiripector
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--rINSPECTED OUTSTANDING ISSUES GRANT FINALTROJECT APPROVAL
Date, Signature
1:temp:b1dg:fomis:oca' rvi 3/25/04 ,
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RECORD OF INSPECTION&
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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Rough -In .................
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Com mercial Final ......
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Gas 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...
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INSULATION ...... L ............
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Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation ........
SH.EETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................