20051072.pdfDATE RECEIVED PERMIT EXPIRES
CITY OF EDMONDS PERMIT
NUMBER ao 0
B SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION 'AODDRESS 77(
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IOWNER NPIMEINAME QF BUSINESS
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CITY ZIP TELEPHONE
NAME
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STATE LICENSE NUMBER
U414iH I E
PROPERTY TAX ACCOUNT P
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ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, BUSINESS C
NUMBER
zip TELEPHONE
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EXPIRAT
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ARCEL NO.
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RESIDENTIAL PLUMBING t MECH
COMMERCIAL COMPLIANCE OR
MIXED USE CHANGE OF USE
MULTIFAMILY SIGN
EGRADING Ei FENCE
I CYDS ( X_
E3 TANK OTHER
-1 RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
IR ACTIVITY) EXPLAIN:
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NUMBER OF
ILID
FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
(3
E3
RW Permit Roduifod
Street Use Permit Requited
113
EXISTING PROPOSED
inspection Required
1-1
Sidewalk Required
E3
REQUIRED DEDICATION FT
Underground
0
I Winne required
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NO. OF FIXTURT
PRV REQUIRED
YES 13 NOO
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
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ENGINEERINjnJEWffB6r L vent connectors rR(ftired
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on fuel -burning appliances passing
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FIRE REVIE6jinugh unheated spaces. IM0603.2 JIM
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VARIANCE OR CU SHORELINE ORADBI I INSPECTION SEPA
REQ'D 01 COMPLETED I EXEMPT
OYES 13N
CA# ZONE SIGN AREA HEIGHT
WAIVERO ALLOWED I PROPOSED ALLOWED I PROPOSED
STUDY 13 1 1
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
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PARKING I LOTAREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
FT.) I REMARKS
11612:1
OF DWELLING SPECIAL INSPECTION
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STORIES UNITS
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DESCRIBE WORK TO BEboNE
REMARKS
GEOTECH REPORT
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STRUCTURAILDE SIGN
BY:
VALUATION
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Description
A16 ':::'C �(j
*LOTSLOP
Plan Check
HtATSOUfPCE?
VESTED DATE
Building Permit
PLAN CHECK NO:
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
Grading
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS. SIDEWALKS, DRIVEWAYS. MARQUEES. ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
Engr. Review
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w PERMIT APPLICATION: SEE ECDC i9.00.o05(A)(5)
Engr. Inspection
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& PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
Fire Review
W 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
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
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
Recording Fee
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
OCCUPANT
GROUP
CONSULTANT
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
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 FOR INSPECTION
WORKMEN'S COMPENSATION INSURANCE AND RCW 18:27.
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SIGN URE (OWNE(O E T):"t DATE SIGNED (425)
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FEE
Plan Chk, Deposit
Receipt #
Total Amt. Due
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Receipt # �n —1
APPLICATION APPROVAL
This application is not a permit until signed by [he
Building Official or his/her Deputy: and Fees are paid. and
receipt is �tcknovvledged in space provided.
FXIALS SIGNA U E DATE
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EAED BY DATE
AT ENTION rl )i t:A L '1 .3,5,3 V
IT IS UNLAWFUL TO USE OR decOPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 i IBC110 i IRC110.
10104 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..........................
Pier/Porch .................
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Retaining Wall ...........
1711
Slab Insulation ..........
PLUMBING:
74 n
Underground .............
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Rough -in ...................
M 0
--1 0
0
Commercial Final ......
1711
HEATING:
1711 z
Gas Test ....................
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-Gas Piping .................
7�0
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0 _n
Equipment ... ..............
Commercial Final ....... .
M M
EXTERIOR SHEATHING
0 ca
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NAILING ..........................
0 1711
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FRAMING ..........................
C 0)
M 0
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FIRST FLOOR FRAMING...
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INSULATION s .................
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FDR—
OCCUPANCY* ...................