20050963.pdfDATE RECEIVED
CIP(bF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP ITELEPHONE
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% I L�� I PERMIT EXPIRES q I ��
PERMIT D o
NUMBER 4
JOB SUITEIAPT#"
ADDRESST)N,� \ (,�; . ��k <S\
PLAT NAMErSUBDIVISION NO. LOT NO, LID NO,
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPAppr=�[3
RW Pemil Required E3
Street Use Perind.Requiled
EXISTING PROPOSED Inspection Requited
Sidewalk Requited E3
REQUIRED DEDICATION FT underground [3
Wifing required E3
METER SIZE LINE SIZE O� OF FIX URES PRV REQUIRED
YESM NO C1 z
1 7 R
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REMARKS Lu
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE z
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ENGINEERING REVIEWEID BY
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� I . VARIANCE OR CU LINE OR ADB# . INSPECTION SEPA
STATE LICENSE NUM13ER EXPIRATION DATE CHECAED BY I REO'D, COMPLETED I EXEMPT
.<::� " C)( A dw� A-? P yl� � 0YES B NO
CA#04—W_;1`- ZONE SIGN ARE,,A HEIGHT
-JI PROPERTYTAXAC RCEL NO.
4 ALLOWED PROPOSED
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WA OPOSED ALLOWED
W R T I IJVD YR
NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SCIR CKS (FT) 4PROPOSED SETBACKS (FT.)
1:1 ALLOWED PROPOSED FRQN��D. ReAlt rft&+T—_6`l"'�L 0
ADDITION D COMMERCIAL tN1 e7 . _ 2
Ei COMPLIANCE OR v 1-I sv. to I It to z
CHANGE OF USE I I I Arl I 61'Clit,0�7 qp
MIXED USE PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ*D VIDED
GRADING FENCE' 17-- 139WI J.—
REPAIR El CYDS El ( X FT.) REMARKS
DEMOLISH TANK OT
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS ORAETI TY)EXP N
CODE —
TYPE OF TION OCCUPANT
GROUP
NUMBER OF
OF DWELLING SPECIAL INSPECTION CONSULTANT OCCUPANT
ITS LOAD
0 STORIES LIN
REQUIRED YES
NUMBER
DESCRIBE WORK TO BE DONE
REMARKS
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GEOTECH REPORT :31
BY:
I C �k_ oy-\ STRUJ=TE IGN -71
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�2 $ 917 1 - ZZ
Description FEE Description FEE
Plan Check State Surcharge
.........
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge
OL OL
PLAN CHECK NO: Plumbing Base Fee
M Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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)
Uj
IL PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Fire Review Plan Chk. Deposit
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
uj MLESS THE CITY OF Fire Inspection Receipt #
_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HAR
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND 3q7
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 Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
Recording Fee Receipt #
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 hisilhor Deputy: and Fees are paid. and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. FI LS SIGNAT RE TE
SIGI� I DATE SIGNED V
/00""
_N!E�R AGENT�, A n-r- 6
4 I_ - L 111 M I I � kn - . I I
771-0220 'REL S B d, ITE
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ATTtNTIO EXT. 132
IT IS UNLAWFUL T SE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 7W — 6
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI- ORIGINt ICT04
�r/FILE - YEL INSPE
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC11I0 / IRC110. PINK -OWNER . GOL ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION;
Footing ......................
Wall..........................
z
Pfer/Porch .................
d
0
Retaining Wall ...........
m
Slab Insulation ..........
PLUMBING:
am
Underground .............
C
m a
Rough -In ...................
0
Commercial Final ......
m
M Z
H EATING:
C z
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Gas Test ....................
co
Gas Piping ...... ..........
0 -n
Equipment .............. I...
Commercial Final .......
mm
Q)
EXTERIOR SHEATHING
0 m
NAILING ..........................
C
Cl)
M 0
FRAMING ........................
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FIR ST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation .......
Cn
z
Ceiling Insulation .......
SHEETROCK NAILING,...
0
m
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...... ............