20050370.pdfFDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
5-/-eijel,
MAILING ADDRESS
71.5— Itlahatri- ..!P/
CITY ZIP TELEPHONE
Ei -77 5-
NAME
ADDRESS
NAME
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ADDRESS
CITY ZIP
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
CHECUD BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW [YRESIDENTIAL PLUM13ING / MECH
ADDITION COMMERCIAL COMPLIANCE OR
OF USE
MIXED USE CHANGE
El REMODEL MULTIFAMILY SIGN
GRADING /FENCE
REPAIR CYDS ED ( _Af X Z, FT.)
DEMOLISH TANK OTHER A 15L6 Y t�
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
(TYPE OF USE,, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
STORIES
UNITS
PERMIT EXPIRES
PERMIT
NUMBER Ij
JOB SUITEIAPTfs
ADDRESS zloq
PLAT NAMEISUBDIVISION NO.
LOT NO.
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LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
E3
E3
RW Permit Required
13
EXISTING -,f-PROPOSED
Street Use Permit Required
Inspection Required
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Sidewalk Required
E3
E3
REQUIRED DEDICATION FT_
Underground
Witinq required
METER SIZE
LINE SIZE
NO. OF
FIXTURES
PRV REQUIRED
YES 13 NO13
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWE9-aY DATE
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FIRE REVIEWED BY DATE Lu
VARIANCE OR CU
SHORELINE ORADE111
INSPECTION
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SIGN AREA
HEIGHT
WAIVER
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ALLOWED,,PROPOSED
ALLOW
RO?Osia�
STUDYA
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED
SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
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PARKING
LOTAREA
PLANNING REVIEWED BY
DATE
REQ'D PROVIDED
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REMARKS\i..--
SPECIAL INSPECTION
REQUIRED OYES
1 CODE
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CONSULTANT
OCCUPANT
GROUP
OCCUPANT
LOAD
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
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ZA05
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORM
BE DONE ON PRIVATE PROPERTY ONLY. ANY, CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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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
PAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
r: 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
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NO R LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
ecording ' I
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. CALL Building Official or hisihor Deputy: and Fees ate paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED I receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO rFOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. FFI A S SIGNATUR DATE
SIGNATUR WNE EMT): DATE SIGNED (425) C A k��12 A
7 -0220
4 71 R
ATkENTION EXT. 13'313
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.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
BY
ORIGINAL - FILE YELLOW - INSPFCTC
PINK -OWNER GOLD - ASSESSOR
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By order of the Building Official for the
City of Edmonds
All persons Are Ordered to
STOP WORK
and imprisonment.
City of Edmonds Development Services Department Building Division
121 5"' Ave N - Edmonds, WA 98020 , (425) 771-0220
Office Hours M-F 9-12 and 1-4
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ............ I ..............
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Pier/Porch ................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
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Underground .............
3
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0
—110
Rough -In .... ..............
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Commercial Final ......
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HEATING:
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Gas Test .....
CO)
Gas Piping ................ 1.
0 _n
Equipment ..................
MM
Commercial Final .......
0 CO)
0 r
EXTERIOR SHEATHING
0 M
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NAILING ......
0)
'FRAMING .........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
0
SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
MISCELLANEOUS .........
FINAL APPROVAL FOR
�,-6=13ANCY ..................