20050973.pdfDATE RECEIVED
PERMIT EXPIRE
PERMIT .1�
CITY OF EDMONDS NUMBER -097
CONSTRUCTION PERMIT APPLICATION JOB 3-
ADDRESS SUITE/ T#
R NAM INAME OF B ?
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PLAT NAMEISUB DIVISION NO. LOT NO. LID NO,
Cr MAILING ADDRESS
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LID FEE $
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0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCPApproved 0
Li� RW Permit Roquited 0
CITY ZIP TELEPHONE EXISTING PROPOSED SIM01 USO PerMll ROquited 13
2 Inspoction Required 13
715 REQUIRED DEDIC Pnjargiound
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NAME CBLP
/A ENGINEERING RE71EWED 13Y
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STATE LICENSE NUMBER EXPIRATFIO/ND TE CHECKED BY VARIANCE OR CU SHORELINE OR ADB# INSPECTION SEPA
'21016 RECI'D COMPLETED EXEMPT
113 YES E3 NOI
J PROPERTY TAX 'ACCOt NT PARCEL NO. CA# ZONE
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LU WAIVERO ALLOWED PRO OSED ALLOWED , PROPOSED
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E3 NEW RESIDENTIAL - - ----- LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
V� COMMERCIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE .......
ADDITION E] COMPLIANCE OR 0
CHANGE OF USE z
MIXED USE 2
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El REMODEL PARKING LOTAREA PLANNING REVIEWED BY DATE 5
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REPAIR El GRADING CYCS FENCE
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OTHER
DEMOLISH El TANK
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIREALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
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VALUATION
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At// Description— FEE Description FEE
Plan Check State Surcharge
HEATS56uR_C_E__ LOTSLOPE% F___7ESTED DATE
PLAN CHECK NO: Building Permit City Surcharge A -kj
Plumbing Base Fee
00
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2
It Engr. Review
W PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
116 1 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 SUCCESSORS Fire Review
Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
Receipt #
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
5A 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.-
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1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee _-TReceipt # Lcyz I
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a pernut until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy, and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
-1 -_ I
IGN RE(OWNER A - E 3. . ), I DATg SIG19D (425) O'E-NIALS SIGNATM. I DATE
K I x k 05
771-0220 RELEjDB)_
ATtEN ' TION EXT. 1.333
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 if IRC110. ORIGINAL FILE - YELLOW INSPECTOR
PINK -OWNER - GOLD - ASSESSOR
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall........................... I
Pier/Porch .................
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Retaining Wall ...........
0,
Slab, Insulation ..........
PLUMBING:
0
Underground .............
M
C
M
Rough -In ...................
0
0
Commercial Final ......
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HEATING:
M Z
Gas Test ....................
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Gas Piping .................
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Equipment .................
Commercial Final .......
M M
EXTER . IOR SHEATHING
0 C13
0 r
NAILING ..........................
0 171
C W
FRAMING .........................
M C/)
M 0
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FIRST FLOOR FRAMING...
INSULATION ...................
--------
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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