20050848.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILINGAD&VSS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY Z113 ITELEPHONE
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"PERMIT
NUMBER
PERMIT EXPIRES
JOB
ADDRESS
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IAPT#
PLAT NAME/SUBDIVISION NO,
LOT NO
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
IESCPAPPmed
13
0
RW Perrmil Requited
13
EXISTING PROPOSED
street Use Pennij Required
Inspection Required
0
Sidewalk Requited
0
E3
REQUIRED DEDICATION FT
Underground
13
Mine rmulted
METER SIZE LINE SIZE NO� OF FIXTURES
PRV REQUIRED
YES13 NOO
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
Lu
NAME
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ENGINEERING REVIEWED BY DATE
ADDRESS V
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FIRE REVIEWED BY DATE ul
CITY XP
TELEPHONE
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VARIANCE OR CU
SHORELINE ORADIIN
INSPECTION
SEPA
STATE LICENSE NUMBER EXPIRATION DATE
CHECKED BY
ECKED BY
REO'D
COMPLETIED EXEMPT
L
13YEs ONO
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CA#
ZONE
SIGN AREA
HEIGHT
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0
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PROPERTY TAX ACCOUNT PARCEL NO.
0 o (90 z7(0
WAIVER 13
ALLOWED I PROPOSED
ALLOWED , PROPOSED
_FPLUMBING
STUDY 13
ECM
El NEW f2rRESIDENTIAL / MECH
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
OR
E!(ADDITION COMMERCIAL COMPLIANCE OR
I
FE
El MIXED USE CHANGE OF USE
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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El MULTIFAMILY SIGN
REQ'D PROVIDED
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GRADING FENCE
M REPAIR CYDS El X FT)
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REMARKS
OTHER
E] DEMOLISH TANK
RETAINING WALL FIRE SPRINKLER
_z3/1GARAGE
CARPORT ROCKERY FIREALARM
(TYPE OF E IN:ZRAC IIVITY)i EPLAIN:
TY=TION
OCCUPANT
GROUP
NUMBER
NUMBER OF
uj
OF DWELLING SPECIAL INSPECTION CONSULTANT
wol STORIES GLAL"'� UNITS
DESCRIBE WORK T(? BE DONE REQUIRED E3 YES
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit
PLAN CHECK NO: Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE. Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6) Engr. Inspection 10
SEE BACK OF PINK PERMIT FOR MORE INFORMATION A
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
0: Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp.
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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
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
WORKMEN'S SgUPENSATION INSURANCE AND RCW 18:27.
SIGNATU 0 R AGENT): DATE SIGNED (425)
MELEASt ZDaA T E(/
C-7 p-ee � I //i
771-0220 -15 EfY
A I I r. 114 1 1 %J IIII
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1109 /.IBC110 / IRC110.
OCCUPANT
LOAD
FEE Description FEE
State Surcharge
City Surcharge Z �2
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
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Receipt # Fly r— I
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
,,% receipt is acknowledged in space provided.
ALS SIGNA DATE
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
0
PLUMBING:
Underground .............
CO)
Rough -In ........... .......
0 M
C
Commercial Final ......
M
-40
0
HEATING:
C
M,
Gas Test ............. ......
M Z
10 -.1
Gas Piping ..............
C z
Equipment .................
Commercial Final .......
0-n
-n
EXTERIOR SHEATHING
M M
NAILING .....................
0 CO)
FRAMING .............. ..........
OM
C CJ)
FIRST FLOOR FRAMING...
M 0
z
INSULATION ................... .
Floor Insulation
Wall Insulation ...........
Z
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
M.
MISCELLANEOUS ..........
FINAL-A���
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