20050729.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Miller
MAILING ADDRESS
_I'A' 1,41x L-1 f. 1 .1 1 V L,4,f
CITY TELEPHONE
ADDRESS
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ADDRESS.
CITY ZIP
CBL#
LICENSE NUMBER EXPIRATION DATE I CHECKED BY
I UID I I PERMIT EXPIRES
ERMIT
NUMBER
JJ c
OB SUITEIAPT#j
ADDRESS
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PLAT NAMEISUBDIVISION NO.
LOT NO.
LID NO
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LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
i Pernia Required [3
Street Use i Requiied
EXISTING PROPOSED
inspection Required
Sicowalk Requitea E3
REQUIRED DEDICA1 ION FT
Undieground 13
[3
Wainq required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 N013 z
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REMARKS W
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE z
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADBI S�PEEO�ION SEPA
IN D COMPLET
CI YES 0 NOI
DROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE SIGN AREA HEIGHT
SZ180 o6o 0jo 60 WAIVER;r- ALLOW ROPOSED ALLOWED , PROPOSE
STUDY 13 N A 1:2, S' N i
NEW RESIDENTIAL PLUMBING / MEC;H LOT COVERAGE (F&RrFkW9ETBA:;?SVF PROPOSED SETBACKS (Fl.)
ALLOWED PROPOSED rRi ii RE0 FFi . Fi _ RIS!"R
1:1 COMMERCIAL
ADDITION COMPLIANCE OR tv JC> �J' 6icke-'.l
rf" =11 f #-.r% I A
REMODEL
REPAIR
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13
1:1
MIXED USE
MULTIFAMILY
GRADING
CYDS
CHANGE OF USE.
SIGN
FENCE
( x FT.)
t r-, I FJ I -T. 1
PARKING
REO'D PROVIDED
LOTAREA
-
PLANN'ING REVIEWED BY DATE
93A24A,141
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REMARKS
DEMOLISH
0
TANK
OTHER't2Mi(___...,
GARAGE
CARPORT
1:1
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
0
P_
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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TYPE OF !MTION
OCCUPANT
GRID
NUMBER
NUMBER OF
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OF
DWELLING
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SPECIAL INSPECTION
OCCUPANT
0
STORIES -Z
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REQUIRED 13YES
FCONSULTANT
LOAD
DESCRIBE WO TO BE DON 00
REMARKS
o., It, Deck AT-
6� HO i SC—
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
`312ALI
VALUATION
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
LOT SLOPE%
VESTED DATE
Building Permit
bty Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK To
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS. DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
la
ice
W
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
U) APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
U)
Fire Review
Plan Chk. Deposit
I I I � ou
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due -
ola''
_j
LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
+
INOR
-
Recording Fee
Rece
Receipt #
IHEREBYACKN OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION APPRO;7JAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
This application is not a perinit until signed by the
THE OWNER. I AGREE 1*0 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 his/her Deputy: and Foes 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.
Y
SIGNATURE D t TE
GN D
S1,151TATUR (OWR �RAGZE DATE Sl E
I 1�
(425)
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771-0220
Y DA:TE
ATTENTION
EXT. 1333
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
G AL V-E - ELL W - INSPEAR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110.
PINS -OWNER D -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR. DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
W611..... ....................
Pier/Porch .................
Z.
Retaining Wall . ...........
slab Insulation ..........
M
PLUMBING:
-n
Underground ..............
Cj) —1
0
Rough -In ...............
M
C I
1711 0
0
—10
Commercial Final ......
0
HEATING:
C
X M
M Z
Gas Test ....................
C z
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Gas Piping .................
W
Equipment .................
0-n
Commercial Final .......
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EXTERIOR SHEATHING
MITI.
NAILING ...........................
0 r
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FRAMING ........................
0
FIRST FLOOR FRAMING ...
MO
Z r
INSULATION ...................
Floor'Insulation .........
Wall Insulation ...........
z
Ceiling Insulation .......
x
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
'0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................