20050362.pdfI DATE RE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
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NAME CBLN
ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION D CiIACKED 13%
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
451 RESIDENTIAL
ADDITION
[_� COMMERCIAL
El MIXED USE
REMODEL
1:1 MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
NUMBER
NUMBER OF
OF
S (A
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES Z
PERMIT
NUMBER
JOB SUITE/APT#
ADDRESS,
Z/X, 1/;�,/
PLAT NAMEISUBDIVISION NO
LOT NO
I
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Required
EXISTING PROPOSED
Inspection Required
Side*jlk Required
REQUIRED DEDICATION FT
Underground
Witing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NOO
REMARKS
OWN ERiCON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
CA#
A r
WAIVER 13
A I
STUDY 13
T
PLUMBING I MECH
LOT COVERAGE
ALLOWED PROPOSED
At
COMPLIANCE OR
CHANGE OF USE
I
SIGN
PARKING
REQ'D PROVIDED
FENCE
( x FT.)
I
RE MARKS
OTHER
EFIRE SPRINKLER
] FIREALARM
CON
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
HEAT SOURCE
j
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES 07L 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.
Grading
Engr. Review
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
'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. -
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
SHORELINE ORADB11 I INSPECTION01 SEPA
REQ'D COfAPLrTED EXEMPT
13YES 13N i
ZONE SIGN AREA HEIGHT
I ALLOWED . PROPOSED I ALLOWED . PROPOSED
0
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Lu
z
a
z
LU
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
z
2
Z
LOT AREA I PLANNING REVIEWED BY DATE
CL
CONSULTANT
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION.JNSVIRANCE AND IRCW 18:27.
DATE SIGNED
(425)
OCCUPANT
GROUP
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due J
4/,2 1��
III Receipt # Ixe/ ,, !;,
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FICPLS SIGNATURE DAT
T
I k - ( x I I] b 11111 f 1 -11 _UI&4U` D BY
ATTE14TION EXT. 1333
IT IS UNLAWFUL TO SE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
�'O
A FINAL INSPEC ION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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or
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................. z
0
Retaining Wall ...........
0
Slab Insulation .......... M
PLUMBING:
Underground .............
M
C
Rough -in ................... M 0
0
0
Commercial Final ...... 0 C
M
HEATING: ITI z
Gas Test .................... C:
Gas Piping ................. 3:
Equipment ................. 0 -n
n
Commercial Final ....... __4
M ITI
EXTERIOR SHEATHING 055
NAILING .......................... 0 r-
0 M
FRAMING ........................ C ch
F. Cn
ITI 0
FIRST FLOOR FRAMING ... Z r
INSULATION ...................
Floor Insulation .........
z
Wall insulation ........... --I
3:
Ceiling Insulation ....... 0)
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................