20051001.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION,
OWNER NAMEINAME OF BUSINESS
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Lot I Y ZIP TELEPHONE
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NAME
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NAME CBL#
ADDRESS
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CITY ZIP
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STATE LICENSE NUMBER EXPIRATION DATE C1W5KI
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PROegRTY TAX ACCOUNT PARCEL NO.
1, 1
- / PERMIT EXPIRES
PERMIT 7
NUMBER
JOB
ADDRESS SUITE/APT#
PLAT NAME/SUBDIVISION NO,
LOT NO,
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESrPApp(ovea E3
RINPernia Required 13
EXISTING PROPOSED
Street Use Permit Required 0
Inspeclion Required E3
Sidowalk Required 0
REQUIRED DEDICATION
Underground [3
—FT_
Wiring required 0
METER SIZE LINE SIZE
PRV REQUIRED
YES 13 NOO
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REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
,.DATE
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VARIANCE OR CU SHORELINE RADB# INSPECTION SEPA
REO'D COMPLETED I EXEMPT
CA# ZONE 13YES 13NOI
SIGN AREA HEIGHT
WAIVER ALLOWED PROPOSED ALLOWED , PROPOSED
STUDY 13 = -1 1 1
Lj NEW
RESIDENTIAL
PLUMBING/MECH
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT.)
COMMERCIAL
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
ADDITION
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MIXED USE
CHANGE OF USE
PARKING
REQ'D PROVIDED
LOTAREA
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PLANNING REVIEWED BY DATE
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REMODEL
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SIGN
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REPAIR
DEMOLISH
GARAGE
CARPORT
GRADING
CYDS
TANK
RETAINING WALL
ROCKERY
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIREALARM
REMARKS
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER ZIMBER OF
OF DWELLING
STORIES UNITS
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TYPE OF C 4STRUICTION
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CODE
OCCUPANT
GROUP
SPECIAL INSPECTION
REQ UIRED
CONSULTANT
OCCUPANT
LOAD
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DESCRIBE 0 BE DONE
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GEOTECH REPORT
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STRUCTURAL DESIGN
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VALUATION
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Description
FEE
Description
Plan Check
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State Surcharge
HEATFOURCE
LOTSLOPE%
VESTED DATE
Building Permit
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City Surcharge
PLAN CHECK NO:
174
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Plumbing
Base Fee
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. f HIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES,.ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Mechanical
Grading
Engr. Review
PERMIT APPLICATION: SEE ECDC 19-00.005(A)(5)
PERMIT LIMIT., SEE ECDC 19-00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Engr. Inspection
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ADDAI�AM ^UnCUA
FEE
�r Wr nia OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS rtre KeVieW Plan Chk. Deposit
_1 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
0: 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
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 #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. This application is not a pennit 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 Foes 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'SCOMPENSAT!?193 URANCEANDRCW18:27.
OFFI IGN URE DATE
SIGNATU K. DATE SIGNED
(425)
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CI8LP
771-0220 'REI EASED BY
DAT
ATTENTION 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 / IBC110 if IRC1110. ORIGINAL -FILE YELL W IN ECTOR
PINK -OWNER GOLD - ASS SSOR
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORDOF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
Underground ...........
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Rough -in ...................
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Commercial Final ......
0
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HEATING:
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Gas Test ....................
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-Gas
--4.
Piping .................
3:
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
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14AILING ...... ...................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
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