20051013.pdfDATE RECEIVED
CITY OFEDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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CITY ZIP TELEPHONE
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NAME
TELEPHONE
IPERMIT EXPIRES
PERMIT
NUMBER
JOB
ADDRESS
SUITE/APT$$
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PLAT NAME/SUBDIVISION NO. LOT NO LID NO
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approed
RW Permit Rpquifud C3
Street Use Pernid Requsled 13
EXISTING _PROPOSED Inspection Requited
Sidowilk Riquirt-d
REQUIRED DEDICATION FT Undefqround 13
Wainq fectinfed
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STATE LICENSE NUMBER EXPIRATION DATE VARIANCE OR CU SHORELINE RADBO INSPECTION SEPA
c REO'D COMPLETED EXEMPT
AL im L_ if P D C) Vol 13 YES 13 NO
PROPERTY TAX ACCOUNT PARCEL NO. \j CA# ZONE SIGN AREA HEIGH
WAIVER ALLOWED PROPOSED ALLOWED I PROPOSED
W 0 6()60 STUDY 13
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NEW P�,RESIDENTIAIL PLUMBING CMECH) LOTCOVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.).
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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COMMERCIAL COMPLIANC
ADDITION 1:1 z
MIXED USE CHANGE OF USE z
PARKING LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D PROVIDED7
6" �C, C.R_ GRADING FENCE I
REPAIR CYDS ( x FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE o RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIREALARM
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OCCUPAN
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NUMBER
NUMBER OF
OF
DWELLING
SPECIAL INSPECTION
CONSULTANT
OCCUPANT
STORIES
UNITS
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DESCRIBE WORK TO BE DONE
REMARKS
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BY:
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L Description FEE
Plan Check
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit
PLAN CHECK NO: Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON. PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
2— DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
W
PERMIT LIMIT. SEE ECDC 19.00.005(A)(6) Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Description FEE
State Surcharge
City Surcharge
Base Fee
V) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
to
Fire Review
Plan Chk. Deposit
UJI 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
Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
Landscapelnsp.
Total Amt. Due
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
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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Recording Fee
Receipt #
APPLICATION APPROVAL
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
This application is not a permit until signed by the
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
Building Official or hisiher Deputy, and Fees are paid, and
IN VIOLATION OF THE LABO CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt i ylr�nowledged in space provided
1IFFI S. GN WURI DATE
WORKMEN'S COMPENSATION I!NXFRANCE AND RCW 18:27.
01 r I I
SIG URE(OW AGENT):
DATE SIGNED
C/
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771-0220
RELEASEABY I I DATE
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 / IRC1110.
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1IGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .............
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch .................
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
Underground .............
M
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Rough -In ......... .........
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Commercial -Final . ......
M
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HEATING:
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Gas Test .................
-Gas Piping ................
Equipment .................
Commercial Final
3:
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EXTERIOR SHEATHING
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NAILING ..........................
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�FRAMING . ........................
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FIRST FLOOR FRAMING...
INSULATION ...................
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Floor Insulation .........
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u ation ...........
Wall Ins I
Coiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION....
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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