20050978.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINES
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PERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
71
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PLAT NAMEISUBDIVISION NO,
LOT NO.
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LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved
0
RW Permit Required
Required
[3
0
EXISTING PROPOSED
Street Use Permit
inspection Required
13
Sidewalk Required
C1
[3
REQUIRED DEDICATION ____ FT
underground
Wirma fenuired
C3
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQ UIRED
YES13 NO13
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION
CONTROUDRAINAGE
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on to the req
Hued expansion tank shall be
FIRE RE VAWWWO. 0nall hot water tanks.DATE
1-11C
VARIANCE OR CU SHOREIINEORADB# I INSPECTION SEPA
REO'D COMPLETED EXEMPT
CI YES 13NOI I
CAft ZONE SIGN AREA ' HEIGHT
WAIVER 13 ALLOWED I PROPOSED I ALLOWED PROPOSED
STUDY 13 1 1 1
NEW RESIDENTIAL Ell I MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
M 013 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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COMMERCIAL
ADDITION COfPLIANCE OR z
CHANGE OF USE 2
MIXED USE z
El REMODEL PARKING LOTARE NING REVIEWED BY DATE
MULTIFAMILY SIGN PROVIDED
GRADING FENCE
REPAIR CYOS X FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL E] FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
1= (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYF,�F CONST TIQN OCCUPANT
GRr%f1R1
uj NUMBER NUMBER OF bn
a OF DWELLING
M SPE61AL INSPECTION CONSULTANT OCCUPANT
o STORIES UNITS LOAD
REQUIRED 13YES
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
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BY:
STRUCTURAL DESIGN
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V0,1J2lA- h7l&-Y VALUATION
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Description FEE Description FEE
AlPlan Check State Surcharge
o 2 12-�4i�lee-1
H NS-1 T VESTED DATE
t4T �OU E LOT SLOPLFO/. Building Permit City -Surcharge /s,
PLAN CHECK NO: Plumbing Base Fee
T141S PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO. Mechanical
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
:2 DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
t: SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: SEE ECDC 19-00.005(A)(5)
116 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, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
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_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
x Fire Inspection Receipt #
It 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due'
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN 15 CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO CkMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a permit until signed by the
TION; AND IN DOING THE WOR"UTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building official or his/her Deputy and Fees are paid. and
IN VIOLATION OF THE LABOR DQDE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIONj receipt is acknowledged in space provided
WORKMEN'S cOMPENS NCE AND RCW 18:27.
U� Fl LS ftATURE DATf
SIONATU (OWNER OR ENT). DATE SIGNED (4251 k7AS
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771-0220 `RE A I BtIlli,/ CAT
ATfE4TION 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 - 114SPECTOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 I 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..........................
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Pier/Porch .................
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Retaining Wall ............
Slab Insulation ..........
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PLUMBING:
M
C
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Underground .............
0
—10
Rough -in ....................
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Commercial Final ......
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HEATING:
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Gas Test ....................
*Gas Piping ...........
0
Equipment .................
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Commercial Final .......
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0 M
EXTERIOR SHEATHING
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NAILING ..........................
M 0
FRAMING .........................
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FIRST FLOOR FRAMING...
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INSULATION ...................
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Floor Insulation .........
Wall In ulation ...........
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Ceiling Insulation .......
-4
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................