20050738.pdfDATE RECEIVED '7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME)NAME OF BUSINESS
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MAILINGADDRESS
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CITY ZIP TILEPH NE
NAME
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PERMIT EXPIRES
PERMIT -7 �3K
NUMBER Zz �_S_
,OB SUITDAIT�
ADDRESS
PLAT NAMEISUBDIVISION NO LOT NO LID 11
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
R
EXIS71NG — PROPOSED
REQUIRED DEDICATION FT
Y,IRIREOUIREII
SO AGO
R MARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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NEW
RESIDENTIAL
PLUMBINGIMECH
ADDITION
COMMERCIAL
COMPLIANCE OR
MIXED USE
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
MREPAIR
GRADING C,DS
(FENCE K FT)
n DEMOLISH
TANK
R4,
GARAGE
CARPORT
Ei RETAINING WALL
ROCKERY
L�M
El FiR�ALARM
OF I DWELLING
STORIES 4— Lci r) UNITS
m-
FIRE REVIEWED BY
DATE
VARIANCE OR CU
SHORELINE OR65B. )
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AREA HEIGHT
WAIVER
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'USIGN
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STUDY
LOT COVERAGE
ALLOWED PROPOSED ,
REQUIRED SETBACK$ (FT)
FRONT SIDE REAR
PROPOSED SETBACK$ (FT1
FRONT URSIDE REAR
2�5 1/. 1 1 c-
JE) 1c), Is,
No J14
PARKING
LOTAREA PLANNING REVIEWED By DATE
REOD PROVIDED
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41 1)1A, A j 08/DI1109
[]rFr CODE 1 0 DURANT
C
GROUP
S CIALIN111CTIO1 CONSULTANT OCCUPANT
PE LOAD
REQUIRED 13 YES m;",
VALUATION
$ lq_?,�,
q.ATE
Description
FEE
Description
FEE
't I'
'_ I '/ /'
Plan Check
,7347
,.1. Surcharge
IT)
-T—HEKT—SOURCE j Lot SLOPE -A VESTED DATE
VESTED
Building Permit
City Surcharge
/5--
PLAN CHECK NO:
Plumbing
Base Fee
EM -
mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY, ANY DO STRUCTION ON THE PUBIC
93 DONMAIN (CURB% SIDEWALKS, DRIvEWAY% MARQUEES, IETC.j WILL REQUIRE
SEPARATE PERMISSION�
Eng, Review
PERMIT APP [CATION: SEE ECDC Iti.0.006(A)(5)
Engr. Inspection
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON 13EHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
Pl.nChk.Dep-�it 11q—
IN NTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-6
EDMONDS, WASHINGTON, TS OFFICIALS, EMPLOYEES, AND AGECNTLYF.RR-M ANY AND
L DIRE No RED Ly
AL CLAIMS FOR DAMAGES OF WHATEVER NATURE� ARISING
Fire Inspection
eceipt #
FROM THE ISSUANCE 0 THIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
tat Amt. Due �, /1P J
DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
C Y WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.
NOR LIMIT IN AN
1,
-41�5_114 f
—
Recording Fee
Receipt Is -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE NFORMATION
APPI ICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
Th,..,pj,P A m 0 ��q Y, ft
THE OWNER� I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC
CALL
TFON; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOY D
LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
IN VIOLATION OF THE
WORK.EN'S COMPENS2�=CE AND RCW 111:27.
DATE
-_
SIG TURE(OWNERO . — oATE SIGNED
(425)
7M7�KE
j
am
'RELEASED
It (,/2n/05_
1 1 11.11.11440
By
ATTENTION
EXT. 1333
V/
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL -FILE - YELLOW - hSPECT6
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I IRC110.
PINK -OWNER GOLD - ASSESSOR
IBM 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 ...........
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Slab Insulation ..........
0
PLUMBING:
Underground .............
Rough -in ...................
0
IT
Commercial Final
M a
0
HEATING:
0
0 C
Gas Test ....................
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Gas Piping ..........
> --1
Equipment .................
Commercial Final
0 "n
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EXTERIOR SHEATHING
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3:
NAILING ..........................
M M
FRAMING ............ ...........
0
0
FIRST FLOOR FRAMING
0 F;
a a)
INSULATION ...................
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Floor Insulation
Wall Insulation ...........
x
Ceiling Insulation
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SHEETROCK NAILING
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SPECIAL INSPECTION
0
IT
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................