20050792.pdfJ-4.11.�
FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAJOEINAME OFeStWLINESS
NAME
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STATE LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO._
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RESIDENTIAL
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ADDITION
COMMERCIAL
MIXED USE
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REMODEL
MULTIFAMILY
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REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
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RETAINING WALL
ROCKERY
jTYPE OF USE,BUSINESS ORAFIVITY) EXPLAIN.
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NUMBER NUMBER OF
OF DWELLING
STORIES 2, UNITS
DESCRIBE WORK TO BE DONE
UMBING MECH
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CHANGE OF USE
SIGN
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( X FT.)
OTHER
FIRE SPRINKLER
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PERMIT EXPIRES
IPERMIT
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PLAT NAME/SUBDIVISION NO. LOT NO LID NO�
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved
RW Permit Required E3
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOTAREA PLANNING REVIEWED BY DATE
REQ'D . PROVIDED 1 1).
REMARKS
TYPE
SPECIAL INSPECTION
REQUIRED 13 YES
REMARKS
CONSULTANT
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GROUP
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VALUATION
Description
FEE Description FEE
Plan Check
State Surcharge
HEAT SOURCE LOTSLOPE% ESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base, Fee
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
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PERMIT APPLICATION: SEE ECDC 19.00,005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
Engr. Inspection
60
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
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-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
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
4
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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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
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Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
Receipt # Ir'-WI
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
P7PPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY wi rH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is not a pormil until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or hisihor Deputy: and Fees arc paid, and
OF THE
IN VIOLATION OF,THE LAS STATE OF WASHINGTON RELATING TO
FOR INSPECTION receipt is acknowledged in space provided
S�QIDE
WORKMEN'S CO�IPENSA- ANCE AND RCW 18:27.
OFFICIALS SIGNATURE D TE
SIGNP)T DATE SIGNED
(425)
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RELEASED BY VIT E
MENTION
EXT. 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A
FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
ORIGINAL - FILE YELLOW - INSPECTOR
FICATE
OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4
COPIES
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FINAL PROJECT APPROVAL FORM
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ...................
FOUNDATION:,
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Pier/Porch .........
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Retaining. Wall .... ......
Slab Insulation ..........
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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 ...................
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Commercial Final .......
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EXTERIOR SHEATHING
NAILING ..........................
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FRAMING ..... ..................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .......
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Wall insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FO R
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OCCUPANCY ..................