20050671.pdfI
DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMEMAME OF BUSINESS
MAILING ADDRESS
CITY Z'IP
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NAME
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CITY
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CITY
STATE
PROPERTYTAX
TELEPHONE
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NUMBER EXPIRATION DATE
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
MIXED USE
REMODEL
F2/MULTIFAMILY
E]
REPAIR
E] N
GRADING CYDS
E]
DEMOLISH
E]
TANK
GARAGE
o
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS CTIVITY) EXPLAIN.
7P x b / yh A cf
4 LUMBING if MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x
OTHER
FIRE SPRINKLER
FIREALARM
[PEPERMIT EXPIRES
�ERMIT
N U M B E R
JOB SUITE!APT#
ADDRESS LI;
PtAT NAMLISUBDIVISiON NO
LOI NO
LID NO,
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LID FEE $
PUBLIC F41GHT OF WAY PER OFFICIAi STREET MAP
tESCPAPProved
13
13
Fi�V Pervid Required
Street Use Perini Requited
0
EXISTING PROPOSED
iiispecison Required
11
S.fju*.j1k Required
0
REQUIRED DEDICATION FT
Underground
13
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METER SIZE
LINE SIZE
OF I IXTURES
PRV REQUIRED
1
YESO NO 13
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR FROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Ui
BY VARIANCE OR CU ELINE RADBits INS'3PEEOTION SEPA
r I o I COMPLIFT
C CA "I - 13 Y I ES 13 NO ED I EXIMPT
AH ZONE SIGN AREA HEIGHT
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W WAIVER 13 ALLOVVILD PROPOSED ALLOViED , PROPOSED
STt
STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
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PARKING LOTAREA LANNING REVIEWED BY DATE 5
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tREQ'r, , PROVIDED 1P
FT.) I REMARKS
NUMBER NUMBER OF
OF DWELLING.,;�—_ S FiEfl'AL417SLPtC�TtION
STORIES :3 1 UNITS REQUIRED 13YES
DESnf E WORK TO BE DONE
REMARKS
7
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EOTECH REPORT
BY:
STRUCTURAL DESIGN
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CODEO'S I OCCUPANT
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CONSULTANT OCCUPANT
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Description
FEE
Description
FEE
Plan Check
State Surcharge
City Surcharge
HEATSOURCE
LOT SLOPE%
VESTED DATE Building Permit
PLAN CHECK NO: I Z�7
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
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
Plan ChIs. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt ts
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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Total Aml Due
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DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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
Thi5 application ;S riot j IW111111 LJoIPI L,,iqr'vd tiy Itic
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
Building Offic!al or histtiur Depuly ar),I d and
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
FOR INSPECTION
receipl
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
OFFICIALS SIGNA10RE )ATF
Al DATE SIGNED
SIGNATURE (DW9ER Oil AGENTV-'-- "17-
(425)
Irv\ I)e
> REL� . _DBY
771-0220 -ASL 1)
ATTENTION EXT. 1333
IT IS UNLAWFUCTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL -FILF Y�LLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 if 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
OCCUPANCY ..................
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