20050971.pdfDATE RECEIVE
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION D TE CHECKED By
PROPERTY TAX ACCOUNT PARCEL NO. 7
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3 ADDITION COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
PERMIT
NUMBER
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ADDRESS
PERMIT EXPIRES
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PLAT NAMEiSUBDIVISiON NO.
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S'jeel Use Permit RP4uired
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ENGINEERIN R§t�r
FIRE REVIEWED BY
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VARIANCE OR CU SHORELINE RADBI I INSPECTIO SEPA
REO'D � "PLETED I EXEMPT
13YES 13NOICO
CAN ZONE SIGN IRE' HEIGHT
WAIVER 0 ALLC,.I:. I PR.P.S.E. ALLOWED , PROPO.SED
STUDY 13
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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LOT
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REMARKS
DEMOLISH TANK E:] OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER OF
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DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
Plan Check
HEAT SOURCE LOTSLOPE%' VESTED DATE
Building Permit
PLAN CHECK NO: Plumbing do
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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.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5) Engr. Review
16
IL PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) "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 Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0_j 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.2
ml = 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 '
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
SIGNAAJRE (OWNER OddrIGELT),j DAT� SIGNFD
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CONSULTANT OCCUPANT
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FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due 6950
1 Receipt #
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 acknDWIedged in space provided
PCIAL64)(3NAILIRE f i DATF
NTION 777 = 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.
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 1 IBC110 / IRC110.
10/cm PRESS HARD - YOU ARE MAKING 4 COPIES
DATE
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:.
Footing......................
Wall..........................
Pier/Porch ....... .........
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0
Retil ning all ...........
0
M
Slab Insulation ..........
PLUMBING:..
0
Underground .............
M
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Rough -In ...................
0
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Commercial Final ......
3:
HEATING:
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..Gas Test ....................
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-Gas Piping ...................
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Equipment .................
Commercial Final .......
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SHEATHING
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EXTERIOR
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NAILING ...........................
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FRAMING .........................
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
3:
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Wall Insulation ...........
C eiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................