20050923.pdfDATE RECEIVED
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CITY OF EDMONDS NUMBER rX 0 15�_() W
CONSTRUCTION PERMIT APPLICATION JOB /APT#
ADDRESS eZ
OWNER NAMEiNAME OF BUSINESS
PI AT NAMEISUBDIVISION NO. LOT NO, LID NO
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MAILING ADDRESS
LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved E3
RW Permit R c tied I
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CITY Street Use Permit Required
ZIP TELEP11ONE EXISTING PROPOSED Inspection Required [3
Sidewalk Reautred 13
REQUIRED DEDICATION Mn grovnd 13
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NAME METER SIZE 'i�66F M*)ftt(J�g 6 P EQUIRED
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#6 VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
STATE LICENSE NUMBER EXPIRATION DAT CHECW B REO'D COMPLETED I EXEMPT
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PROPERTY TAX ACCOUNT PARCEL NO. I cAtt SIGN AREA HEIGHT
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NEW ESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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MIXED USE 13 CHANGE OF USE z
PARKING LOTAREA DATE
REMODEL MULTIFAMILY 13 SIGN R E a - �D 'PROVIDED PLANNING REVIEWED BY
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REPAIR CYDS X FT.) REMARKS
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DEMOLISH. TANK
GARAGE RETAINING WAL L FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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REMARKS
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Description FEE Description FEE
HE ATSOURCE LOT SLOPE7_ . ____7VESTED DATE PI - an Check State Surch I 6rge
f--j I 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
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT: SEE ECDC `19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
LL)
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY I
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 Landscapelnsp. Total Amt. Due
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NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt # ;t) q1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABQR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSAT;pf��RANCE AND RCW 18:27. TE
01�NS UR D11
SIGN E (OWILNEROR ENT): DATE.SIGNEp (425)
771-0220 RELEA� BY) DIE
AfTbNTION 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. UBC1109 / IBC110 if IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall. ...........................
Pier/Porch .................
Retaining Wall ...........
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Slab Insulation ..........
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PLUMBING:
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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E�uipment .................
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Commercial Final
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ..... a ..................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING ...
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SPECIAL INSPECTION ..
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MISCELLANEOUS .........
FINAL APPROVAL FOR
OCCUPANCY ..................