20050702.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNEF3 NAMEINAM OF BIASINESS
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
TELEPHONE
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER E:
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PROPERTY TAX ACCOUNT PARCEL NO.
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ADDITION COMMERCIAL
MIXED USE
REMODEL El MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
1 GARAGE RETAINING WALL
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-CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN;
[PERMITEXPIRES
OERMIT
NUMBER 0,02,
JOB 11
ADDRESS
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PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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RW Per,,,, Required
13
EXIST114G
Street use Pernid Requited
inspection Required
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-PROPOSED
Sidewalk Required
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REQUIRED DEDICATION FT
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Mimi required
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METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERING REVIEWED 13Y DATE
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INSPECTION
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COMPLETED EXEMPT
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LOT COVERAGE REQUIRED SETBACKS [FT PROPOSED SETBACKS (FT.)
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PLUMBING / MECH
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ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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REMARKS
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FIRE SPRINKLER"
FIRE ALARM
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DESCRIB WORK TO BE DONE � A
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VALUATION
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Description
Plan Check:
HEAT SOURCE
LOTSLOPE%
VESTED DATE
Building Permit
PLAN CHECK NO: ----------
Plumbing
Mechanical
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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.
Grading
Engr. Review
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PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT. SEE ECDC 19.00.OnS(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
OCCUPANT
GROUP
CONSULTANT
OCCUPANT
LOAD
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FEE Description
State Surcharge,
City Surcharge
Base Fee
FEE
n *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
F EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
r ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 0
cc R INDIRECTLY
r FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.* e,
x Recording Be It 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 This application is not 6 permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Orlicial or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in spa,,.e provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COM PENsATjo"SU RANCE AND RCW 18:27. OFF�-,ALS VG&NATIfIE DjVE-
SIGNATUPE (OWI�ER OR NT DATE Sit ED (425)
2 to 771-0220 RELEASED BY DATE�
ATTENTION EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINAL FILE YELLOW INSPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 f IBC1`10 / 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......... ....... ...........
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Pier/Porch . .................
Retaining wall ...........
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Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -In ...................
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Commercial Final ......
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HEATING:
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Gas Test ....................
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'Gas Piping .................
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Equipment ... ...............
Commercial Final ......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
INSULATION ...................
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Floor Insulation ......... .
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................