20050399.pdfCEIVED PERMIT EXPIRES
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PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPTft
ADDRESS
OWNER NAME/NAME OF BUSINESS ZL, 4. 12�_AL
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Pi AT NAME/SUBDIVISION NO.
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LOT NO.
LID NO.
LID FEE $
MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
tEXISTING
TESCPAppfoved
RW Pernut Required
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Streel Li5e Parnul Required
Required
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CITY
ZIP
P
TELEPHONE
PROPOSED
inspection
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7_�.
/17
7
REQUIRED DED, ICATION FT
Sidewalk Required
underground
Wiring required
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NAME
METER SIZE
LINE SIZE
0. OF FIXTURES
PRV REQUIRED
1�1 ADDRESS
NAME
ADDRESS
STATE LICENSE NUMBER
ZIP TELEPHONE
EXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL 140.
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NEW RESIDENTIAL
COMMERCIAL
ADDITION
MIXED USE
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
GARAGE RETAINING WALL
CBL#
YES 13 NOM z
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REMARKS z I
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE 51
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
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DATE
DATE UJI
0:
1 9:
CHECKED BY VARIANCE OR Cu SHORELINE OR ADB# INSPECTION SEPA
RECI'D 'RETEl' EXEMPT
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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FIRE SPRINKLER
10 YES 13NOI
CA# ZONE SIGN AREA HEIGHT
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W A V E R r ALLOWED PROPOSED ALLOWED PROPOSED
WAIVER 13 fas �, I
S T U Y
STUDY 0 .V
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
LOTI
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/ I SIDE REAR
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3
0
PARKING
LOTAREA
PLANNING REVIEWED BY DATE
REQ'D PROVIDED
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TYPE jQF CONSTRUCTION
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Lit NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT
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UPANT
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WORK -TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
-97
STRUCTURAL DESIGN
BY:
VALU ATION
Description
FEE Description FEE
Plan Check
/Iow State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
li- BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE: PUBIC
Grading
i DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
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I= SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
ILL
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
LO 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Plan Chk. Deposit
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt # 1, 1
x 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
Landscapeinsp.
Total Amt. Due 76t)
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0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE. PROVISION.*
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Ll 1r,
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPROVAI
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 his/her Deputy: and Foes are paid, and
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
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
o FFIfA!1iIiS SIGNATU DATE
S ATUR OWNE16" A NT): DATE SIGNED
(4425)
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771-0220
-TrE_Ltk%ED BY ATE
ATTENTION
EXT. 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
��RIG AL - FILE VELLOW - INSPECTOR
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FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 If IBC110 / IRC110.
P -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......... ............
FOUNDATION:
Footing ......................
Wall .......................
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Pier/Porch . .................
Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
Underground .............
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0
M
Rough -in ...................
0 C
'Commercial Final ......
1711
HEATING:
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Gas Test ....................
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Gas Piping ...............
Equipment ..................
Commercial Final ........
M M
EXTERIOR SHEATHING
0 M
NAILING ..........................
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FRAMING ..... ...................
M 0
Z r
FIRST FLOOR FRAMING...
INSULATION ...................
C3
Floor Insulation .........
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Wall Insulation ...........
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Coiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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