20050453.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA7E/NAME OF BUSINE S!t_,�
,f I . . I
MAILING ADD5LSS
<7
CITY jTELEPH6NE
NAME
ADDRESS
CITY ZIP ITELEPHONE
PERMIT EXPIRES A-14i X5 /A
P6RMIT
NUMBER
JOB
ADORE ss'2.,L,/
SUITEIAPT#
PLAT NAMEISUBDIVISION NO
LOT NO.
3
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApprovea
RW Permit Required
EXISTING PROPOSED
Street use Pernin Requited
Inspection Required
Siclawaik ROqUffed
REQUIRED DEDICATION
FT
Undoigfound
__
Wiling required
METER SIZE
LINE SIZE
NO OF FIXTURES
PRV REQUIRED
I
I
YESO NO 13
REMARKS
OWNER�CONTRACTOR RESPONSIBLE FOR EROSION CONTRODDRAINAGE
LD
z
E
Lu
Lu
z
E3
z
UJI
NAME CBL#
ENGINEERING REVIEWED BY DATE
vx,
ADDRESS
FIRE REVIEWED BY DATE W
CIT`Y TELEPHONE 0:
Z
�X�.
_.( ��11 � // — VARIANCE OR CU SHORELINE ORADEII INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATIO DATE
I "HECKED BY REO'D COMPLEIED I EXEMPT
011"I X� I 13YES 13NO I
CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
\j WAIVERC3 PROPOSED
r., I ALLOWED , PROPOSED ALLOWED
u 'Al
STUDY 13
PROPOSED SETB
NEW RESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) ACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION 2
MIXED USE CHANGE OF USE L - I z
PARKING LOTAREA PLANN114G REVIEWED BY DATE
El REMODEL El MULTIFAMILY SIGN REO'D I PROVIDED
GRAOING� Ei FENCE
REPAIR CYOS I X FT,) REMARKS
E] DEMOLISH !fR:�TANK El OTHER
GARAGE RETAINING WALL FIRE SPRINKLER—
z CARPORT 1:1 ROCKERY El FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN.
TYPE OF CONSTRUCTION CODE. OCCUPANT
I - � N GROUP
U
uj NUMBER NUMBER 0
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
I UNITS REQUIRED LOAD
STORIES
DESCRIBE WORK TO BE DONE
REMARKS
z
133
aaz 101 1'1�1�11111141 Zz GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
$
Description FEE Description FEL_
Plan Check State Surcharge
NEAT SIUIRCE LOTSLOPE% VESTED DATE I
City Surcharge
Building Permit
PLAN CHECK NO: Plumbing Base Fee
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 Grading
_j
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
w
PERMIT LIMIT: SEE ECDC 19.00.005JA)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESSORS Fire Review :an Chk. Deposit
Ui IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
Receipt ft
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF T141S 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.'
xi 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 WQR� AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OFJH� LABOI CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION 114SURANCE AND RCW 18:27.
OFFICIALS SIGNAIURE CAT
SIGNATU OR AdENT): DATE SI ED
(425) ?-1 y-
A-I) 771-0220 R - E
ATTEKTJbN 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-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIE
ED BY
FILV -
ASSESSOR
z
0
11
0
M
4 -n
3:
M
C
M 0
0
-4 (-)
0 C
-4 ?.
3: M
M Z
jo -i
—Z
:c
C/)
q -n
n
M M
0 —C/)
0 r_
0 M
C co
9 Cn
M
Z
X
z
--i
a:
Cn
z
0
M
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 0s,
OCCUPANCY ..................
5.9 W 011 115 7
zoo
Tile Initials MT are Milton
Thompson, a temporary contract
inspector For tile City.
z
0
1
0
M
=i 95