20050889.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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ADDRESS
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_ICENSE NUMBER
RTY TAX ACCOUNT PARCEL NO.
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ADDITION
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REPAIR
DEMOLISH
GARAGE
CARPORT
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RESIDENTIAL
COMMERCIAL
MIXED USE
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
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PERMIT EXPIRES
PERMIT
NUMBER S__
JOB SUITE/APTft
ADDRESS 176
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PLAT NAME/SUBDIVISION NO. LOT NO LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPAPPro J
RvV Permit Required
street use Permit Requited
EXISTING PROPOSED
inspection Required
Sidewalk Reoutired
REQUIRED DEDICATION FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
Y SM NO13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL)DRAINAGE
EERING REVIEWED BY
BY
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1 ZEC115f Y I VARIANCE OR CU
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
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FIREALARM
DATE
DATE
SHORELINE OR ADB# I INSPEC 'ON SEPA
REQTD COPAPLETED EXEMPT
13YES 13NOI I
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CA# ZONE SIGN AREA HEIGHT
WAIVER13 ALLOWED I PROPOSED ALLOWED , PROPOSED
STUDY 13
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LOT COVERAGE REQUIRED SETBACKS (FT PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR 115
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PARKING LOT'AREA I PLANNING REVIEWED BY DATE
REO'D PROVIDED
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TYPE (W)CONEITIFUCTION
NUMBER NUMBER 6'F
OF DWELLINI
STORIES UNITS
SPECIAL INSPE�TION
REQUIRED 13 YES
DESCRIBE WORK TO BE DONE
REMARKS
adGEOTEC
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BY:
STRUCTURAL DESIGN
BY:
VALUATION
Desc4tion
Plan Check
HEAT SOURCr__�_
LOT SLOPE% J
VESTED DATE
Building Permit
PLAN 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
W
916
PERMIT APPLICATION: SEE ECDC i9.00.005(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 SUCCESSOR
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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
S Fire Review
Fire Inspection
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVE 4 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'N
DING 7
E WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATiO
OF TH
LABOR CODE TH STATE OF WASHINGTON RELATING To
FOR INSPECTION
WORKMEN'S
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ATT� EXT. 1333
IT IS UN�'kA L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL C-CTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC1091 IBC110 I IRC110-
10104 PRESS HARD - YOU, ARE MAKING 4 COPIES
OCCUPANT
GROUP
.TANT
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
f
Receipt # Z7 56it
APFLICATION APPROVAL
This application is not a purnill until signed by [tic
Building Official or hinfher Deputy' and Fees are paid, and
rocoAis acknovAedged in space provided
rir.IAI.-;sANATURF 11 (DATE
ORIGINAL, -FILE YELLOW - INSPCCIOP
PINK -OWNER GOLD - ASSESqr
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining,Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground .............
Rough -in ...................
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Commercial Final
0
......
HEATING:
M
M z
Gas Test ....................
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Gas Piping .................
Equipment ..................
Commercial Final ......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING
. .......................
C 0)
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FIRST FLOOR FRAMING...
Q 0
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INSULATION ....................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
6000,