20050452.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAIr,'NAME OF BUSIN9S
MAILING ADDRE
NAME
ZIP TELEP11ONE
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STATt LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
MIXED USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS ( X_
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS PR ACTIVVTY) EXPtjAjN,
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,re5,
NUMBER
OF
NUMBER OF -
DWELLING
STORIES
UNITS
r�L
DESCRIBE WORK TO BE DONE
PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
0'7 4s -�kj
PLAT NAME/SUBDiVISION NO.
LOT NO
LID NO
5 -'- 03
P
1
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved 13
RW Penrl Requ,ree
Sineet Use Permit Requited
0
EXISTING PROPOSED
Inspection Required
S,de�alk Requirml E3
C3
REQUIRED DEDICATION FT
Undetground
Ming fliquacd
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO13 z
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W
REMARKS W
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADB# INSPECTION SE A
REQ'D JCGMPLETED EXEMP7
113YES 13NO
CAft ZONE SIGN AREA HEIGH
WAIVER 13 ALLOWED I PROPOSED I ALLOWED , PROPOSED
STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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PARKING
REO'D IPROVI:ILTAREA I PLANNING REVIEWED BY DATE
FT
REMARKS
Ou CE LOTSLOPE% VESTED DATE
PL:AkCHECK NO: 0
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.
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
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 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
C NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION.QF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKME=�hTION INSURANCE AND RCW 18:27.
SIGN DATF-7;ED
ioWNE AGENT):
TYV CONSTAFTION CrQ.E OCCUPAN
GROUP
SPECIAL INSPECTION CONSULTANT OCCUPANT
REQUIREI I I LOAD
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
OF
(425)
771-0220 RE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or hisnwr Deputy and Fees are paid, and
receipt is acknowledged in space provided
FICIALS SIGNATURE I DATF
ATTENTION CAI. 'I J1515
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- -FILE
OR I AL
.OW R
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. OWNER
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
LLOW - INSPECTC
DLD - ASSESSOR
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0
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch ................. 0
Retaining Wall ...........
0
ITI
Slab Insulation ..........
PLUMBING:
M
Underground ............. C
M
0
Rough -In ................... 0
0
Commercial Final ...... -4
3: M
M z
HEATING:
C z
GasTest ....................
Gas Piping .................
0 -n
-n
Equipment .................
Commercial Final ....... M M
EXTERIOR SHEATHING 0
NAILING .......................... 0 M
C: W
9 Cn
FRAMING ........................ M 0
Z
FIRST FLOOR FRAMING...
INSULATION ...................
>
Floor Insulation ......... z
--I
Wall Insulation ...........
cn
Ceiling Insulation ....... z
0
SHEETROCK NAILING i
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR pg_
OCCUPANCY ..................
o V5Z
'File initials NIT are Miltoll
niollipson, a temporary contract
inspector fbi- tile City.