20050677.pdfDATE RECEIVED c -7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
NAME/NAME OF BUSINESS
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MAILINGAIDDRESS
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CIT'� ZIP TELEPHONE
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NAME
ADDRESS
TELEPHONE
MCKIAW�(?y
ADDRESS
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CITY ZIP TELEPHONE
50 .( - -7e/'73
/71 (;KL e- /- , .-1,7) 1 -f- (
STATE LICENSE NUMBER EXPIRATION DATE Cff C E
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PROPERTY TAX ACCOUNT PARCEL NO.
NEW
;EK�IRESIDENTIAL'
13
PLUMBING I MECH
ADDITION
COMMERCIAL
1:1
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
1:1
SIGN
REPAIR
GRADING
CYDS
1:1
FENCE
X FT.)
DEMOLISH
TANK
GARAGE
[3
RETAINING WALL.
FIRE SPRINKLER
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CARPORT
ROCKERY
FIREALARM
(TYPE OF USE, BUSINESS OR AC
TY) EXPLAIN:
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NUMBER
NUMBER OF
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DESCRIBE WORK TO BE DONE
PERMIT EXPIRES fy/ rp_��
PERMIT
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UMBER
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JOB SUITEIAPTN
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street use Permit Requited
EXISTING PROPOSED
Inspection Required
Siduivalk Required
REQUIRED DEDICATION FT
underground
Waing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I
YES 13 NOM
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
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REMARKS
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REMARKS
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GEO TECH REPORT
BY:
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STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE Description FEE
Plan Check
State Surcharge
HEA,T SOURCE LOTSLOPE% VESTED DATE
A'
Building Pe rmit
City Surcharge
PLAN CHECK NO:
ix*�
Plumbing
Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Mechanical
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 Chk. Deposit
ui IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt # gz
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
Landscapeinsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AP�LIC�ATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a purmit until signed by the
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
CALL
Building Official or hisihor Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
F1 SIGNATU E DATE
SIGNAT E(OWNERORA NT)o; D
(425)
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771-0220
E
ED BY
ATTENTION
EXT. 1333
61
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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-
ORII INAL - FILE LOW JINJECTOR
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VOLDW
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 / IRC110.,
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .... .....................
Pier/Porch ......... ........
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Reta.ining Wall ............
0
M
Slab Insulation ..........
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PLUMBING:
cf)
Underground ..........
M
C
M 0
-InRough ......................
0
Commercial Final ......
.0 C::
x ITI
HEATING:.
ITI z
Gas Test ... ................
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Gas Piping .................
CO)
Equipment . .................
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Commercial Final .......
M.M
EXTERIOR SHEATHING
NAILING ...........................
0 M,
C 0).
CO)
FRAMING ........................
M 0
FIRST FLOOR FRAMING ...
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INSULATION ...................
;U
Floor Insulation .........
>
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Wall Insulation ...........
x
Ceiling insulation .......
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SHEETROCK NAILING
0
SPECIAL INSPECTION
MISCELLANEOUS .......... .
FINAL APPROVAL FOR
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OCCUPANCY ................
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