20050670.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRES
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CITY ZIP tLEPHONE
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NAME
ADDRESS
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PA19
ADDRESS
CITY ZIP ELEPHONE
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STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO.
[;3'*`NNEW
RESIDENTIAL
COMMERCIAL
ADDITION
D USE
REMODEL
1ULTIFAMILY
REPAIR
E3
GRADING CYDS
DEMOLISH
El
TANK
GARAGE
E3
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN
U)
uj NUMBER
C' OF
M 0 STORIES
DESCEUBtANORK TO BE DONE
NUMBER C
DWELLING
UNITS
PLUMBIN< �EC
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( — X
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OTHER
FIRE SPRINKLER
FIREALARM
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PERMIT
NUMBER
JOB
ADDRESS
PERMIT EXPIRES 1-1/
SUITE/APT#
PLAT NAME/SUBDIVISION NO
LUI NU
LID NO
I
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIPApproved
13
RW Remit Required
0
EXISTING PROPOSED---
Street use Ptrina Required
13
13
inspection Required
Sicle*alk Required
E3
REQUIRED DEDICATION FT
Untleiground
13
vNifincifeQuired
[3
METER SIZE
LINE SIZE
PRV REQUIRED
YES13 NO 11
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
VARIANCE OR CU SHORELINE OR ADB$s INSPECTION I SEPA
REO'D COMPLETED EXEMPT
113YES [3NO1 I
CA# ZONE SIGN AREA HE IGHT
WAIVER 13 ALLOWED I PROPOSIM ALLOVVED PROPOSED
STUDY [3 1 1 1 1
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE in
REQ'D . PROVIDED I I (L
FT.) I REMARKS
TYPY)���C I N I C901E JOCCUPANT
GROUP
SPECIAL INSPECTION CONSULTANT OdUPANT
I REQUIRED13 YES I I LOAD
REMARKS
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GEOTECH REPORT
A-71
BY:
STRUCTURAL DESIGN
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by:
VALUATION
$
Description
Plan Check
HEAT LOT SLOPE% ESTED DATE
Building Permit
PLAN CHECK NO*
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
Grading
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(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
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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 THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
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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. -
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 CALL
TION: AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE L.�_0011 CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSA'151�*,�U RANCE AND RCW 18:27.
SIGNATURE - "(0 91EAOR GEN DATE SIGNED (425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
12:30
Plan Chk. Dep osit
Receipt III
Total Amt. Due
Receipt #
X
APPLICATION APPROVAV_
Tnis applic,ition is not., perno until -signed by Ine
Building O"IC1,11 Or his/her Deputy and Fees ire paid and
roceiPt isdckno,�,led9eLj in space provided
OFFICIALS SIGNATURF ATE
RFLEASE10 [1)" IJAI E
7
,ATTE I r—A 1.
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL - FILE - YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110. PINK -OWNER - GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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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
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OCCUPANCY ..................
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