20050905.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION. PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
ILM MAILINGADDRESS
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CITY ZIP TELEPHONE
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NAME
ADDRESS
PERMIT EXPIRES
1 PERMIT
NUMBER
JOB SUITEIAPT#
ADDRESS
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ADDRESS
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CITY ZIP TELEPHONE
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LICENSE NUMBER
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
RESIDENTIAL
COMMERCIAL
ADDITION
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYD
DEMOLISH
TANK
EGARAGE
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EIROCKERY
RETAINING WALL
CARPORT
(TYPE OF USE. BUSINESS OR ACTIVITY)-FXPL&W�/
PLAT NAME 'SUBDIVISION NO.
LOT NO
LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCIFiApproved
E3
RW Permit Required
stroot use Pernid Required
13
EXISTING-_ PROPOSED
Inspection Required
[3
Sidewilk Riquired
E3
REQUIRED DEDICATION FT
Underground
Wiring mquiled
C3
[3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 NO13
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REMARKS
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OWNER]CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
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ALLOWED I PROPOSED
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ALL WED PROPOSED
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STUDY 13
. LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
PLUMBING CiECH)
ALLOWED PROPOSED
FRONT SIDE REAR
FRO NT L/RSIDE REAR
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COMPI IANC
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CHANGE OF USE
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PARKING
LOTAREA
PLANNING REVIEWED BY DATE
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OTHER
FIRE SPRINKLER
FIREALARM
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NUMBER NUMBER OF
a OF DWELLING
STORIES UNITS
SPECIAL INSPECTION
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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$
2��,000 90TU
Descrip�ion"""""""`
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Plan Check
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VESTED DATE
Building Permit
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PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURDS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
t= SEPARATE PERMISSION.
Engr. Review
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11: PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
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PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIR S, ASSIGNS AND SUCCESSORS
W 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 ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Fire Review
Fire Inspection
Landscapelnsp.
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Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
�-IIICN 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 CONSTRILIC- 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 COMPENS=NCE AND RCW 18:27.
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SIGN=ATUWNER 0 GE
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FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
To tal Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Depuy* and Fees ate paid. and
receipt is acknowledged in space provided
FICIALS SIGNATURE 11 DATq
W011111111 ft�le EXT. 1333
ATTENTION
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. UBC109 / IBC110 / IRC110.
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ORIGINAL -FILE - YELLOW - INSPECTOR
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-RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
wall ..........................
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Pier/Porch .................
Retaining Wall ..........
Slab Insulation ..........
74 96
PLUMBING:
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Underground .............
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0
0,
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Rough -in ...................
C.
Commercial Final ......
3: M
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HEATING:
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Gas Test ....
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Gas Piping .................
0 -n
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Equipment . .................
171 M
Commercial Final .......
EXTERIOR SHEATHING
0 M
C CD
NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation ...
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Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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