20051014.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAIVIE OF BUSINESS
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MAILING ADDRESS
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CITY zip TELEPHONE
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NAME
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PERMIT EXPIRES Z �oc
PERMIT
NUMBER
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PLATNAMEISU So IVI SION NO.
LOT NO
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LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCPApproved 13
RW Permit Required Q
EXISTING PROPOSED
Street use Perind Required 0
Inspochon Require($ 0
REQUIRED DED ;A�111,1 FT
Sicawaii, RN.uvea 13
Underground 0
Witi(if] required 13
METER SIZE aft0flon 0 ffiLQFf64W(d
PRV REQUIll D
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ZIP/ TELEPHONE 0:
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY VA IA0bta4r4,
COM ETED I EXEMPT
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-j PROPERTY TAX ACCOUNT PARCEL NO. CA# ZONE
EIGHT
WAIV&07�"' ALLOWED PROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
A PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMMERCIAL COMPLIANCE OR z
ADDITION z
1:1 CHANGE OF USE I I I z
MIXED USE PARKING LOTAREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED IL
GRADING FENCE
REPAIR CYDS ( X FT.) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIREALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
TYPE-7STR CC)QE--..., OCCUPAN
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LUWB I GROUP
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STORIES __I.!U:NI'Ts
LING
SPECIAL INSPECTION
REQUIRED
CONSULTANT
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
VALUATION
Description
FEE
Description
FEE
/f
Plan Check
State Surcharge
HEAT SOURCE
ILOT SILOPE%
VESTED DATE
Building Permit
City Surcharge
PLAN CHECK NO:
Plumbing
Base Fee
C'7
Q-3
Mechanical
THIS PERMIT AUTHORIZES7NL-Y THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
2
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BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
Engr. Inspection
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) CCESSORS
0 *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SU
Fire Review
Plan Chk. Deposit
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS
_j THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Fire Inspection
Landscapelnsp.
Recording ee
Receipt #
Total Amt. Due
Receipt # �7 I
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
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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
This application is not a pernut until signed by [he
CALL Building Official or his/her Deputy! and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMPENSA�_�IURANCE AND RCW 18:27. ATE SIGN - ED
SIGNAT RE!(OWNER 0 NT,_j D
(425)
F ZSI TURE DATE
—3—(�
771-0220
REU0BY DATE
TENTION
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 I IRC110.
ORIGINAL - FILE YELLOW INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ............ I ..........
Wall...........................
Pier/Porch .................
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Retaining Wall ...........
__4
Slab Insulation ..........
0
171
PLUMBING:
Undergroun .............
Cl) —4
.
:E
M
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Rough -in ...................
M a
'Commercial Final ......
0 0
C
HEATING:
x 171
IT! z
GasTest ....................
r —4
-Gas Piping....� .............
Equipment .................
Commercial Final ......
EXTERIOR SHEATHING
M M
0
NAILING ..........................
0
.0 ITI
FRAMING ........................
C CO)
FIRST FLOOR FRAMING...
171 0
Z
71
INSULATION ...................
Floor Insulation .........
Wail Ins6lation ...........
Z
_4
Ceiling Insulation .......
0)
SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
0
M
MISCELLANEOUS ..........
IT
FINAL APPROVAL FOR
OCCUPANCY ..................