20050664.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
lZ
Uj MAILINGADDRESS
z
I / 7 3 2
0
CITY
NAME
U
Uj
ADDRES`S�
!E
U
CITY
NAME
X ADDRESS
0
l-
J
�z CITY
0
u L S �C'_
I STATE LICENSE —NUMBER
le-1
*00c'.'a z,7__
ZIP TELEPHONE
I
�e.o Z671fz-!�__ :!
ZIP TELEPHOiT�
CBLts
ZIP TELEPHONE
.g�f/0-7 2cK, -,5�r2-
PROPERTY TAX ACCOUNT PARCEL NO.
AA e,— I -0:z / /,
EXPIRATION DATE I CLECKED
[-]
NEW
RESIDENTIAL
E]
ADDITION
COMMERCIAL
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
TYPE OF USE, BUSINESS OR ACTIVITY1 EXPLAIN
x
PLUMBING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — X_
OTHER
FIRE SPRINKLER
FIREALARM
PERMIT EXPIRES
Sle") �S-
PERMIT /2
NUMBER
JOB
ADDRESS SUITEiAPTrs
/ " A
PLAT NAME/SUBDIVISION NO,
LOT NO
LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
T ESCP Apprn,�Sj
RW Permil RequirlId
EXISTING PROPOSED
Street Use Permit Requirea
__
inspection Requiria
SidVA,iii, RequirL�j
0
REQUIRED DEDICATION FT
unaingrourla
waing ivauirvo
METER SIZE LINE SIZE NO OF FIXTURES
I
PRV REQUIRED
YESO NO 13
REMARKS
OVvNERjCONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
7�pc 13 ot- L Vent conlice
I
FIRE REVIEWED BY
DATE
9
0
z
R
W
W
z
5
z
W
tu
cr
rL
VARIANCE OR CU SHORELINE RADB9 I INSPECTION SEPA
REO'D COMPLETED EXEMPT
13 YES [3 NO� I
CA# ZONE SIGN AREA HEIGHT
WAIVER 13 ALLOWED PROPOSED ALL0114ED , PROPOSED
STUDY Ell I I I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
z
z
z
PARKING LOTAREA PLANNING REVIElii E DATE
PROVIDEb V
REQO iylul,,�p bE CL
a IPE 11. 1 %j -
2:1 BY Gil y lNiSPECTOR
FT
REMARKS QNSERVED
AFFIDAVI IS SHAtt NOT
I y?, I- UO STRUCTION CODE OCCUPANT
(7 0`7 GROUP
NUMBER NUMBER OF
OF DWELLING
STORIES PECIAL INSPECTION CONSULTANT OCCUPANT
DESCRIBE WORK TO BE DONE UNITS REQUIRED C LOAD
eaaz_nz�c_ 4,11 tREMARKS —
GEOTECH REPORT
BY:
Rot S S C U SI
TRUCTURAL DESIGN
B ry:
oc�Z4 VALUATION
�r 731, $
1'e-1 x lu a- (z-%
Description
FEE
Description
FEE
1 Plan Chec . k
State Surcharge
HEAT SOURCE
LOT SLOPE7
VESTED DATE
Building Permit
City Surcharge
)14
PLAN CHECK NO:
Plumbing
_<*2
Base Fee
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.
Mechanical
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 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
Plan Chk. Deposit
Fire Inspection
Receipt h
Landscapelnsp
Total Amt. Due
Recording Fee
I
Receipt #
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)
71
7 -022 0
APPLICATION APPROVAL
Th15 IIPPI[CatiDo IS o0l a I)L-flild unlil Silped by vw
Building Official or bisitilj.j nt�puly and F(wsalfl Paid and
e recolpt if) spac'! provided
/FI NAI S SIQNATyJRF, DATE
SIGNATURE (OWNER 0 IJ(C EKT):
DATE SIGNED
13rLE41!If BY DATE
ATTENTION 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 COPIES
ORIGINAL - FILE YELLOW � INSPECTOR
PINK -OWNER GOLD - ASSESSOR
0
z
E5
I
z
0
1
0
M
-A -n
CD
0 M
M 0
0
__10
0 C:
--i K
3: M
M Z
0)
0 _n
n
M M
0
0
0 M
C (n
?I (n
Q C-)
Z
X
__I
:E
z
--i
r
U5
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
yvv
OCCUPANCY ..................
z
0
0
M
--I -n
U5 --I
0 ITI
C
M
0
-40
0
M
M Z
rL) --I
C/)
0 71
_n
__4
x
M M
0
0
0 M
C cl)
?. w
Q 0
Z
z
C/)
z
0
A
0
M