20050405.pdfEIVED
_5 PERMIT EXPIRES
PERMIT
CITY OF EDMONDS NUMBER L
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTP
ADDRESS
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUB71VISION NO. LOT NO. LID NO�
UW MAILING AtOESS LID FEE S
z TESCP Approved 13
RW Permit Required [3
N v� PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 Street use Permit Requited 0
CITY ZIP TELEPHONE EXISTING PROPOSED inspection Required 13
SidowalK Required El
REQUIRED DEDICATION FT Undurgiound 13
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NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
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YES [3 N013
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t= ADDRESS REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NAME
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE Lu
CITY TELEPHONE
0
ZIP
&"hA17 - VARIANCE OR CU SHORELINE OR ADB# INSPECTION ISEPA
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D I COMPLETED I EXEMPT
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CA# ZONE ' SIGN AREA HEIGHT
4 PROPERTY TAX ACCOUNT PARC L NO. ALL
0 WAIVER 13 OWED PROPOSED LLOWED I PROPOSED
LU 0 00 STUDY 13
NEW RESIDENTIAL PLUMBIN LOT COVERAGE R&XIRED V ACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED StOEREAR FRONT LJR SIDE REAR
1 1 -i 7
AL' COMPLIAN5
ADDITION �Q
CHANGE OF USE
III USIP PARKINr,� LOTAREA PLANN04P REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D rOVIDED
GRADING FENCE I I
REPAIR CYDS x FT.) REMARKS
DEMOLISH TANK OTHER AX4
1 GARAGE RETAINING WALL FIRE SPRINKLER +
3 CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS QR A,C IVITY) EXPLAIN:
a. TYMO&RUION CODE� OCCUPANT
rx GROUP
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Lu NUMBER NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
UNITS S LOAD
0 STORIES QUIRED 13YE
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DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
BY:
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BY:
60 3C.— C VALUATION
Description FEE Description FEE
Plan Check State Surcharge
ESTED DATE
HEAT SOURC �7 LOTSLOPE% Building Permit City Surcharge
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT A=S ONLY THE WORK NOTED. THIS PERMIMTCOVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
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t= SEPARATE PERMISSION.
:2 Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n S Fire Review Plan Chk. Deposit
in OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESSOR
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Yj Recording Fee Receipt #
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 his/her Deputy: and Fees 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. OFFICIALS SIGNATURE D E
SIGNATURE (0 E 06� �NTV DATE SIGNED (425) 7
771-0220 RELEASED BY D�TE
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINA� )ILE - YELLOW INSPE�TOR(
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 If IRC 110. PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ..............
z
Retaining Wall ............
0
M
Slab Insulation .. ..........
PLUMBING:
Underground .............
M
M 0
Rough -in ...................
0
C
Commercial Final ......
M
z
HEATING:
—11
C Z
Gas Test ..... ..............
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Gas Piping .... ; .........
Equipment ................ v.
Commercial Final .......
M ITI
EXTERIOR SHEATHING
NAILING ..........................
0 M
C co
FRAMING ........................
M 0
Z
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
3:
Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................