20050451.pdftu
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER;7AMEINAME OF BUSINEsT'
MAILING ADDRESS
ITY
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NAME
ADDRESS
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TELEPHONE
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ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE Cgr.1469 BY
PROPERTY TAXACCOUNT PARCEL NO.
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, U
6 70 0 00 62 0 Y
RESIDENTIAL PLUMBING / MECH
COMMERCIAL COMPLIANCE OR
0 MIXED USE CHANGE OF USE
MULTIFAMILY SIGN
GRADING FENCE
CYDS X FT.)
XTANK OTHER
oRETAINING WALL FIRE SPRINKLER
ROCKERY FIREALARM
SINESS OR ACTIVITY) EXPLAI�
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NUMBER OF
DWELLING '17
UNI
TO BE DONE
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P ERMITEXPIRES lr�A]W�
PERMIT
NUMBER 60S_— 0qS
JOB
ADDRESS�
SUITE/t.PT9
PLAT NAMEISUBDIVISION NO-
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I E SC P ApI1R1o'%'..d 0
13
RivY penr�'j , "'d
13
EXISTING PROPOSED
Street Use Permit Reqwted
inspection Requacia 13
0
Slde�ati,. Required
13
REQUIRED DEDICATION
FT
Underground
Wirinq required 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YESO NOO
REMARKS
OWNERiCONTRACTOR RESPONSIBLE
FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE ORAD1111 I INSPECTION SEPA
REO'D COMPLETED EXEMPT
13YES 13NOI I
CA# ZONE SIGN AREA HEIGHT
WAIVERM ALLOWED , PROPOSED ALLOWED , PROPOSED
STUDY 13 1
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR C)
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PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ'D . PROVIDED I I (L
REMARKS
REQUIRED 13YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
EAT,7�),URCE
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7- 7& I
LOT SLOPE%
1
VESTED DATE
—
Building Permit
PLAN CHECK NO: 315 -31
Plumbing
Mechanical
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.
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
OAPPLICANT. 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION -THE ABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN, SA�t�ION INSURANCE AND RCW 18:27.
SIGNATUR (OW9E R AGENT): DATE SI�NED (425)
5 771-0220
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OCCUPANT
GROUP
FEE Description
State Surcharge
City Surcharge
11, Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until Signed by the
Buildinq Official or his/her Deputy and Fees ate paid. and
receipt is acknowledged in space provided
FFICIALS SIGNAJURE DAT
ATTFENTION t)k L 1 .5,5 .5 1 '�,\
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- INAL%_ FILE LLOW
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. COPI YNK -OWNER OLD -
10104 PRESS HARD - YOU ARE MAKING 41 ES
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CTOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The Initials MT are Milton
Thompson, a temporary contract
inspector for tile City.
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