20050528.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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F( WNER NAME/NAME OF BUSINESS
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ADDRESS
ZIP
ADDRESS
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ZIP
T!LEPHONE
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STATE LICENSE NUMBER
EXPIRATIQV DAIE
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4160165
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PR0PMTY _TAX ACCOUN T PAR
EL NO.
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RESIDENTIAL PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
x FT.)
DEMOLISH
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TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
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(TYPE OF USE, BUSINf SS OR A� ) P AIN: \
PERMIT EXPIRES j,4,LLQ(
PERMIT
NUMBER
JOB PT#
ADDRESS
PLAr NAMEiSUBDIVISION NO. LOT NO 170
I LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
RW Permit Required 13
Street use Permit Required CI
EXISTING PROPOSED I diction Required E3
F I walk Rw4uved 13
n �MUST I If,,,-0rg10und E3
ICATWS PFrP
REQUIRED DED
wit-C aired C3
METER SIZE Uli Uld. F J, V*lIV REQUIRED
YESD NOD
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OWNER/CONTRACTOR RESPONBE PXCUI(IMTROUDRAINA z
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ENJWy" F*VIWEDi`BY DATE
on fliel-burning appliances passing
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VARIANCE OR CU SHORELINE ORAD134 I INSPECTIONJ SEPA
REO'D COMPLETED � EXEMPT
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PROP ReB'SETOACKS (FT.)
ALLOWED PROPOSED
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FRONT URSIDE REAR
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PARKING
LOTAREA
PLANNING REVIEWED BY DATE
REQ'D I PROVIDED
2: TYPE ON'ONSTRqCTION
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uj NUMBER NUMBER OF
0 OF DWELLING SPECIAL INSPECTION CONSULTANT
STORIES I
UNITS
REQUIRED
DESCRIBE WZRK TO BE DONE
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REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
,iW
,PLAN CHECK NO:
Building Permit
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
"APPLICANT. ON BE -HALF 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
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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-
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
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
CALL
FOR INSPECTION
(425)
771 -0220
SIGNATUI E (OWNER ORrGENT
DATE SIGNED
7,
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OCCUPANT
GROUP
OCCUPANT
LOAD
Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
R �1�
eceipt #
APPLICATION APPROVAL
This application is not a ril until signed by the
Building official or hisitier Deputy: and Fees are paid. and
receipt is acknowledged in space provided,
FICIALS SIGNATURE A — i I DATE
AITENTION
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 / IBC11 0 if IRCII 10.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW . INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing......................
Wall... .... ... ... ........ . .
Pier/Porch .................
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Retaining Wall ...........
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Slab jnsylation ..........
PLUMBING:-
.............
MUnderground
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M
Rough -in ...................
--I
0
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Commercial Final ......
—1
M
HEATING:
M z
Gas Test .....................
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Gas Piping ..................
Equipment .................
Commercial Final . .......
3:
M M
EXTERIOR SHEATHING
O.r.
NAILING ........... ................
0 M
C Cn
FRAMING ..... ................
W,
Q 0
Z
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ......
3:
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Ceiling Insulation .......
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SHEETROCK NAILING
0*
SPECIAL INSPECTION
IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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