20050805.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
PERMIT
NUMBER
JOB
ADDRESS
PERMIT EXPIRES
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OWNER NAME/NAME OF BUSINESS
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P PLAT NAME'SUBDIVISION NO.
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LOT NO
LID NO
LID FEE S
MAILING ADDRESS
-7 AIA
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
rEXISTING PROPOSED
REQUIRED DEDICATION FT.
TESCPApproved C3
RW Permit Required E3
Street Use Formit Required M
Inspection Requited E3
Sidewaik Required L3
Underground 0
Wiring required 13
CITY ZIP
N 19 &I/V luolo
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METER SIZE
M T SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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ADDRESS
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CITY zip TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATF i I CHECKED BY ,
PROPERTY TAX ACCOUNT PARCEL NO.
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TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
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El PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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FIRE SPRINKLER
FIREALARM
II YES 13 NO E3
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROU DRAINAGE
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ENGINEERING EVIEWEI BY
DATE
FIRE REVIEWED BY
DATE
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TYPE
CT
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
SPECIAL INSPECTION
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOT ECH REPORT
BY:
STRUCTURAL DESIGN
BY:
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VALUATION
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Description
Plan Check
HEATSOURCE
LOTSLOPE%
STED DATE
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Building Permit
Fil AN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
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)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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
NOR LIMIT IN ANY WAY THE CITY'S A131LITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF]
CONSULTANT
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE. OF WASHINGTON RELATING TO FOR INSPECTION
PENSATIO! RCW 18:27.
_1��E AND
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'1% SI NATU V(1 DATE SIGNED (425)
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771-0220
ATTENTION EXT. 1333
ITIS UNLAWFULTO USE OROCCUPYA BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 / IRC110.
OCCUPANT
GROUP
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due Mob
1 Rec ipt # .&�q
APPLICATION APPROVAL
This application is not a permit until signea by the
Building Official or his/her Deputy- and Fees are paid, and
ro4Tt is acknojedged in space provided
\OASS �IGN�TURE I '. I OkTE
10104 PRESS HARD - YOU ARE MAKINGA COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
�INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation ..........
M
PLUMB ING:
Underground ..... .......
0 M
Rough -In ...................
M 0
0
Commercial Final ......
or
C
1711
HEATING:
ITI z
Gas Test ....................
CE�
Gas Piping ................
Equipment ..................
0 -n
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING ..........................
0 M
FRAMING ........................
0)
FIRST FLOOR FRAMING..-.
Q,0
Z
INSULATION ...................
Floor Insulation .........
z
Wall Insulation ...........
-1
Ceiling Insulation .......
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SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................