20050593.pdfDATE RECEIVED
PERMIT EXPIRES --21 0
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CITY OF EDMONDS
PERMIT
NUMBER
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CONSTRUCTION PERMIT APPLICATION
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OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO.
LOT NO,
LID NO,
P, I LH A Q"D
LID FEE S
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MAILING ADDRESS
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
RW Permil Required
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Street use Parnul Required
CITY ZIP
ELEPHONE
EXISTING PROPOSED
Inspriction Required
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REQUIRED DEDICATION
FT
Sidewatk Required
Underground
Wirina required
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NAME
METER SIZE LINE SIZE
NO. OF FIXTj PRV REQUIRED
YES CI No 13
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ADDRESS
REMARKS
OWNER/CONTRACTOR RESPONSIBLE
FOR EROSION CONTROUDRAINAGE
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CITY ZIP
TELEPHONE
NAME
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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CITY ZIP
TELEPHONE
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VARIANCE OR CU
SHORELINE OR A. DBI
I INSPECTION
REQ*D
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STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
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STUDY 13
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SIGN AREA I
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PROPERTY TAX ACCOUNT PARCEL No.
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NEW RESIDENTIAL PLUMBING I MECH
ADDITION COMMERCIAL COMPLIANCE OR
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EEeREMODEL MULTIFAMILY SIGN
LOT COVERAGE
ALLOWED PROPOSED
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REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT.)
FRONT LJRSIDE REAR
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PARKING
REO'D PROVIDED
LOT AREA
PLANNING REVIEWED BY I )ATE
REPAIR GRADING FENCE
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REMARKS
OTHER
DEMOLISH TANK
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CARPORT ROCKERY. FIRE ALARM
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(TYPE OF USE, BUSINESS ORA T I W1Y
TYPE 0 CTION
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GROUP
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NUMBER
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SPECIAL INSPECTION
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CONSULTANT
OCCUPANT
LOAD
DESCRIBE W6RK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
FEE
Plan Check
16
State Surcharge
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HEAT SOURC5
LOTSLOPE%
VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORKTO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W 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 IN FORMATION
Engr, Inspection
.
.
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0-i DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
Fire Review
Plan Chk.Depo sit
Fire Inspection
Receipt H
Landscapelnsp.
Total Anil. Due
Recordin g Fee
Receipt 0
APP[1CATION APPROVAL
This application is riot it pormit until signed by the
CALL Building official or hisdhar Deputy and Foos are paid,and
receipt is ackn"Judgoid in %ruwu provided
FOR INSPECTION
OFFICIAL DATE
S SIG!�ATURF- -
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 VIOLATIO . HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WO P. SATION INSURANCE AND RCW 18:27.
(425)
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771-0220 �,WVAsrD.,
AGTT):
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DAT.9 SIGNED
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17—Q C:11!16
EXT. 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICA:fE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
ORIGINAL -FILF - N'[LtOW -INSPECTOR
PINK -OWNER - GOLD - ASSESSOfi
110104 PRESS HARD - YOU ARE
MAKING 4 COPIES
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RECORD OF INSPECTIONS
�INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION,
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
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M
Rough -in ..................
M
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Commer cial Final ......
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HEATING:
M
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Gas Test ....................
10
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G as Piping .................
0)
Equipment ....... ..........
0 --n
Commercial Final, .......
_4
EXTERIOR SHEATHING
MM
NAILING........ ; .................
0 M
C: co
FRAMING .............. I ..........
FIRST FLOOR FRAMING ...
0
Z
INSULATION
...................
Floor Insulation .........
Wall Insulation ...........
Z
3:
Ceiling Insulation .......
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C� 31D- 0
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SHEETROCK NAILING
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APP ROVAL FOR
OCCUPANCY ..................
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