20051025.pdfI
CITY OF EDMONDS
CONSTRUCTION, PERMIT APPLICATION
OWN�R YIME/14AME OF BU51.NESS
MAILING ADDRESS
i&508 '726 12?
CITY ZIP TELEPHONE
ZA-Mg-ndgi "'774.
NAME
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PERMIT
NUMBER
PERMIT EXPIRES
[02,5
aw Sul I E/fW 11
ADDRESS i t 4
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U X �' . "70
PLAT NAM EISUBD IVI SION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approvpd
13
El
RVV Petnut Requifed
Si Ue Pormit Requirod
[3
EXISTING PROPOSED
Inspeciton Roquired
C3
SKJowalk Reqwirwl
13
REQUIRED DEDICATION FT
undergfound
[3
C3
Wifing roquired
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
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YESM NOM
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REMARKS
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OWNERICONTRACTOR RESPONSIBLE FOR EROSIO14 CONTROUDRAINAGE
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L4GINJE
ADDRESS f1ji'Ged fJ;' all hot water tanks. DATE
DATE
ZIP TELEPHONE
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W�L - VARIANCE OR CU SHORELINE OR ADB# INSPEC�ION SEPA
Sj(�TE �ICENSE NUMBER CHAKED BY REO D COMPLET61) I EXELIPI
W776 NO F OYES E3NO1
_S 0. P VW CAV ZONE, SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER13 PROPOSED
ST vent C nnect rs req
1:1 NEW RESIDENTIAL PLUMBING / MECH L kGE 11 ED SE BACKS (FT.)
04=6ig COOPNOTS UR DE REAR
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ADDITION COMMERCIAL COMPLIANCE OR C 803.2
1:1 CHANGE OF USE thr4gh unh ated spaces.
MIXED USE P z
NNING REVIEWED BY DATE
13 REMODEL E] MULTIFAMILY SIGN REQ'D PROVIDED LA
GRADING FENCE I
REPAIR M CYOS ( X FT.) REMARKS
DEMOLISH 1:1 TANK Ei OTHER
GARAGE o RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
EA HE
rS re ii�red
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(TYPE OF USE, BUSINESS OR ACTIVITY) E LAIN: TYPE2 N MTN t�ODE OM
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NUMBER OF
OF DWELLING SPECIA INSPECTION OCCUPANT
UNITS LOAD
NUMBER REQUIRED 13YES
STORIES CONSULTANT
.DESC WO 13E DONE
REMARKS
Lj A ff 1`1 j
-ru GEOTECH REPORT
BY:
0A A 6LAL STRUCTURAL DESIGN
BY:
VALUATION
Description FEE Description FEE
PI an Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE Building Permit City Surcharge 161140
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PLAN CHECK NO: Plumbing 0, Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT C - OVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
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
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection- Receipt #
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 Landscapelnsp. Total Amt. Due Loc
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- — f_4 f 050,5��'
Recording Fee Receipt # I i2z
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WPA��t ORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided.
HC
T1 FOR IN
.IN VIOLATION OF THE 'Uk SPECTION
C DE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPE�rION INSbi�NCE AND RCW 18:27. OFFICI DATE
SIGNAJUIFE (OWNER 0 NT): DATE S19INED (4,251
Al2- 771-0220 _RELEAA�Z\ DAIE
AT-feNTION tZA L '1,3a*3
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. UBC1091 IBC110 / IRC110.
10/04 PRESS HARD - YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS.
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ...... ................
Wall..........................
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Pier/Porch .................
Retaining Wall .� .........
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Slab Insulation ..........
PLUMBING:
1711
C
Underground .............
M 0
0
0
Rough -in ...................
C
M
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping ..................
0.M
Equipment .................
M M
Commercial Final .......
EXTERIOR SHEATHING
0 M
C
NAILING .. ........................
C
M 0
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FRAMING ..................
FIRST FLOOR FRAMING...
;U
3:
INSULATION ...................
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Floor Insulation .........
Wall Insulation ...........
CA
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL -POW
OcefITIMMY . ..................