20050349.pdfDATE RECEIVED
PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAME�NAME OF BUSINESS I
MAILING ADDRESS
7,25
CITY ZIP TELE HD�E
99,
Eolr7olv,05 782�� 1.: 5;'33 -�Pliq
NAME
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TELEPHONE
NAME CBLP
DAV 4- Al 17-F- PL-M 16 4-wrr4 IW-009,
ADDRESS
16-oq
/ 3 ;W, Ming,
CITY
Zip
I TELEPHONE
1�ytjmwoao
%10-7142-5
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STATE LICENSE NUMBER
EXPIRATION DATE
CR
DAY,iiii�f,044ciyt,
1�2_-0_7
PROPERTY TAX ACCOUNT PARCEL NO.
OVIq
010000C11292922
1:1 NEW
RESIDENTIAL
PLUMBING / MECH
1:1 ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
MIXED USE
0 REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS ( X
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
o RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVKTY) EXPI�AII�4. A
PLAT NAMEISUBQVISION NO
PERMITEXPIRES
3
SUITE/APT#
pu) -5,tv
LOT NO LID NO
LID FEE S
in ed 13
PUBLIC RIGHT OF WAY FbTk
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13
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REQUIRED DEDIC ON __&r_r_tnAjjfTC
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METER SIZE
LIN
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ED
PRV REQUIRED
YES 13 NO 13
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REMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY
DATE
FIRE REVIEWED BY DATE ui
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BY _:3tI.ClR�.�1PRA�B#_3 NlWfgC SEPA
d .1.4. 'j 1 ft.4a Lt�rm I EXEMPT
FT.)
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE I
; �4,
HEAT SOURCE I LOTSLOPE% I VESTED DATE
PLAN CHECK NO:
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
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
'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 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
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
SIGNATUR DATE SIGNED
,�JOWNER OR GEN
CAH ZONE T-L SIGN AREA
WAIVER13
STUDY 13
LOT COVERAGE
ALLOWED PROPOSED
REQ'D
SPECIAL INSPECTION
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapoinsp.
Recording Fee
oil
PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
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"AR'rAr"
'j1% I t
ectors required
L ve flt�C,100�11�nr �11;r,_Tilol
CONSULTANT
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OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge
Base Fee Yo oo
, 00
CALL
FOR INSPECTION
OF
(425)
771-0220
ATTEN11ON I t: 1. 1 �)aa
IT IS UNLAWFUL 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 I IBC110 / IRC110.
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permil until signed by the
Building Official or his/her Deputy and Fees are paid. and
- receipt is acKnowledged fit Space provided
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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ORIGINAL - Fit-17 YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
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0
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Slab Insulation
PLUMBING:
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Underground .............
Rough -In ...................
M
1711
Commercial Final ......
0
0
0
C
HEATING:
M z
GasTest ....................
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Gas Piping .................
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CIA -
Equipment .................
0 -n
Commercial Final .......
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EXTERIOR SHEATHING
M IT11
NAILING ..........................
0
0
FRAMING ........................
0 M
C: C0
FIRST FLOOR FRAMING...
9 Cn
Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
—4
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SHEETROCK NAILING ...
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0
SPECIAL INSPECTION ...
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IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
05"
OCCUPANCY ..................
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The Initials MT,1l'C Miltoll
Thompson, a temporary contract
inspector rol. tile City.