20050989.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
(a Q-.T,--V-,, \)i-A C- rl--t
MAILING ADDRESS
W T
�1 ".)"-Z-70
0
CITY ZIP TELEPHONE
1� 2-f 7Yq.)L32_1
CDV�to vio-
NAME
F4W
CBLH
FPERMIT EXPIRES
. __ I
PERMIT
NUMBER
JOB
ADDRESS
PLAT NAME/SU7DIVISION NO,
LOT NO
Tk
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING PROPOSED
REQUIRED DEDICATION FT
METER SIZE 1_6NE SIZE _T__NO. OF FIXTURES
ENGINEERING REVIEWED BY
SU
U
LID NO.
LID FEE $
TESCP Approved
13
El
RAF Per lit Ulf
13
Street s , it ilquired
E3
Insp I it d
C3
SK410 U11
13
Und
E3
Win
PRV REQUIRED
YES 13 NO 13
Uj
W
WIt4AGE
z
Z
W
DATE
ADDRESS
DATE ILL!
FIRE REVIEWED BY 0:
CITY Z TELEPHONE
SHORELINE OR ADB# INSPECTION SEPA
CHECKED BY VARIANCE OR CU REQ'D COMPLETED EXEMPT
STAIrLICENSE NUMBER EXPIRATION DAT 13 YES E3 NO
7 CA# ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARg.,,L NO. WAIVER E3 ALLOWED ROPOSED ALLOWED ROPOSED
00 - STUDY 13 1 — I I
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
RESIDENTIAL �LUMBIN MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
NEW z
COMMERCIAL t!C IANC E OR -E
_tc - - z
ADDITION El CHANGE OF USE DATE 5
[0 MIXED USE I PARKING LD ILI
REM ODEL MULTIFAMILY SIGN REQ'D PROVIDED
GRADING FENCE
0 REPAIR CYDS X FT.) REMARKS
OTHER
DEMOLISH TANK
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM 111111
(TYPE OF USE, BUTIN�FSS OR ACTIVIT TYPE TNS ir I Fill I N COD97 GROUP
01 LAR
NUMBE'R' NUMBER OF OCCUPANT
OF DWELLING SPECIAL INSPECTION/ CONSULTANT" LOAD
STORIES UNITS REQUIRED 13YES
DESCRIBE WO 1K TO BE DONE
REMARKS z
Y,
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
:3T Uitz, VALUATION
$
4 Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE Building Permit city Surcharge
PLAN CHECK -NO: Plumbing e- Bas e Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTE I D. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC Grading
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19-00-005(A)(5)
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. Depositl
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF eceipt #
EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection R
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
ANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Totall rnt Due kou
FROM THE ISSU WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp-
DEEMED TO MODIFY, 7�11 1-�xe I
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- eceiot
Recording Fee
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
COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building official or his/her Deputy' and Fees are paid, anti
THE OWNER. I AGREE TO WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED rec pt is acknowledged in space provided.
TION- AND IN DOING THE SPECTION
I E LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR IN
IN VIOLATION OF. ICI LS I ATURE VAT I
WORKMEN'S COMPI*EATION INSURANCE AND RCW '18:27.
A70T): DATE SIG
SIGNATUR NER
I_/q 771-0220 __JDAYIE
CVT 41"I'A
-AfT NTION
ZILAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A F - INAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC1110 / IRC110.
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
z
0
1
0
ITI
--i -n
0)
M
C
rn
0
C)
0 C
M
M Z
C
o -n
n
M M
0
0
0 M
C 0) 1
19 CO)
M 0
Z
7,11
3:
z
--I
z
0
I
0
M
RECORD OF INSPECTIONS,
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
z
Pier/Porch .... ............
Retaining Wall ...........
171
Slab Insulation ..........
q =H
PLUMBING:
M
C
Underground ............
M 0
Rough -In ...................
0
C
Commercial Final ...... .
M
IT! Z!
HEATING:
fv)
C z
r
GasTest ....................
Cn
Gas Piping ...................
0 -n
Equipment .................
__4
Commercial Final .......
M 1711
EXTERIOR SHEATHING
0 ITI
C:
NAILING ..........................
FRAMING ........... ............
M 0
z -
r
--I
FIRST FLOOR FRAMING ...
INSULATION ...................
>
Floor Insulation
'Z
Wall Insulation ...........
z
Ceiling Insulation .......
SHEETROCK NAILING ...
0
171
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY
010
..................