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al�-11 K ii�� —1 1 7PRMIT EXPIRES
DATE R
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PERMIT
CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT0
ADDRESS Aj —
OWNER NAME/NAME OF BUSINESS t Q
zv_q S, PLAT NAMEISUBDIVISION NO. LOT 140. LID NO.
Lx MAILINGADDRESS I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved [3
0 -so Li RW Permit Requited 0
Street Use Permit Required 0
CITY ZIP TELEPHONE EXISTING PROPOSED Inspection Requited 13
Sidewalk Required E3
7Z REQUIRED DEDICATION FT Underground [3
tl� Witing required [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
10- YES 13 NOM
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t= ADDRESS REMARKS W
x E FOR EROSION CONTROL/DRAINAGE z
U OWNER/CONTRACTOR RESPONSIBIL
CITY ZIP TELEPHONE
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NAME CBL#
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ENGINEERING REVIEWED BY DATE
x ADDRESS
FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIR TION DATE VARIANCE OR CU SHORELINE OR ADBO INSPECTION SEPA
CNKED Ej( REQ'D COMPLETED
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\Gc( 0 L CAN ZONE SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
WAIVER-B""o""' ALLOWED PROPOSED ALLOWED PROPOSED
STUDY 13
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NE RESIDENTIAL LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
W LUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMMERCIAL *nLOLMPLIANCE OR
ADDITION
MIXED USE CHANGE OF USE
PARKING LOTAREA NING REVIEWED BY DATI 1
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE
RE I PAIR CYDS X FT.) REMARKS
DEMOLISH TANK OTHER
EGARAGE RETAINING WALL FIRE SPRINKLER
3 CARPORT ROCKERY FIREALARM
too (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
0. TYPEJOF CONSTRUCTION OCCUPAN
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w NUMBER NUMBER OF
OF DWELLING SPECIk:_INSPECTION CONSULTANT OCCUPANT
0 STORIES UNITS A-,11A LOAD
n - REQUIRED 13YES
DESCRIBE WORI TO BE DON iI& f '..
>UAA� REMARKS
"CA—Nek) ip.-S 5-i-clRAQ-E �X� GEOTECH REPORT
BY:
STRUCTURAL DESIGN
BY:
LX:)q`4, C4EI LA,1 L— '�b I it--1 _0SA VALUATION
$ F_
FEE Description FEE
4,,oj_j> Description
Plan Check State Surcharge
HEAT SOURCE LOTSLOPE% VESTED DATE
Building Permit City Surcharge k9
K NO: Plumbing Base Fee
6 Ao 7�
THIS PERMIT AUTHORIZES ONLY THE WORK NOTEd THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
It SEPARATE PERMISSION. Engr, Review
x PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
lu
PERMIT LIMIT: SEE ECDC i9.00.005(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. 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 #
IMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
ALL CLA
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION., Recording -0-0 Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAU/
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 Foes are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space provided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27. OFFICIALS SIGNATURE TE
SIGNAT E (OWN DATC SIGNED (425) q'
771-0220 ASED BY
U
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- ORIGINAL FILE YELLOW ?PEOR
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 Ir IBC110 / IRC110. PINK -OWNER GOLD - ASSESSOR
10104 PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:.
Footing ...... ...............
Wall ..........................
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Pier/Porch .................
Retaining Wall ...........
0
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Slab Insulation ..........
PLUMBING:
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Undergro und .............
M 0
Rough -in ...................
0
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Commercial Final ......
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hKATING:
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GasTest ................
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Gas Piping .................
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Equipment .................
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Commercial Final .......
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EXTERIOR SHEATHING
0 1171
NAILING ..........................
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FRAMING ..... t ..................
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation ........
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SHEETROCK NAILING
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................