20051152.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAMONAME OF BUSINESS
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PERMITEXPIRES
PERMIT
NUMBER
ADDRESS
FLAT - NAVEISUBDIVISKV�O LID NO
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXIST NG PROPOSED _K'Z_n
REOU:RED DEDICATION __ FT . . .......... .
METER SIZE I LINE 11
YEsA NO 0
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDIRAINAGE
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ENGINEERING REVIEWED 5Y
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PLANNINGREVISWEDB DATE
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SPECIAL INSPECTION
CONSULTANT LOAD
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Description
FEE
Description
FEE
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'Ian Check
State Surcharge
HENT SOURCE — UOTSLOPR% VESTE DATE
Building Permit
City Surcharge
PLAN CHECK NO:e
P
plumbing
Base Fee
THIS PEMff AUTHI ONLY THE WORK NOTE . THIS PERMIT COVERS WORK TO
T
Mechanical
HE DONE ON PRIVATE PROPERTY ONLY, ANY CONSTRUCTION ON THE PUBIC
Grading
DONMAIN (CURB% SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
EPARATE PERMISSION.
PERICTAPPLICATION: SEE ECDC 19.00,005(A)(5)
Engr. ReView
PERMIT UMM SEE ECDC 19,00.005(A)(6)
Engr. Inspection
SEE BACKOF PINK PERMIT FORM REINFORMATION
-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 #
ALL LAIMS FOR DAMAGES OF WHATEVER MORE, ARISING DIRECTLY OR INDIRECTLY
TL y
BE
FROM THE I SUANCE OF THIS PERMIT. ISSUANCE 0 THIS PERMIT SHALI No' So,
S at N 'E
OF ANY CITY OR NANCE
Landscapeinsp.
La no T':v
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT
IN
NOR LIMIT INANYWAYTHE CMTS ABILITY TO ENFORCE ANY ORDINANCE PROVIS11 N.'
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Recording Fee
[HERFOYACK OVILEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
N
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APP
ON
APPROVAL"
GIVEN IS CORRECT; AND THAT I AM THE OWNER, 0. THE DULY AUTHORIZED AGENT OF
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THE OWNER. I AGREE TO COMP 11 11D11 S REGULATING CONSTRUC-
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EMPLOYED
CALL
Soldimg 001-1.1 hnon-r 0 op" 1: no F pn,d,.nd
TION; AND ON WILL BE
'NGTH.-.R.AUT. fNSTRAETBFY, NO PENS To
'N 00 , THE _ OF WASHINGTON RELATING To
T .1 THE LAMO- CODE
FOR INSPECTION
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1. VIOLATION
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WORKMEN'S COMPENSATION INSUM EA RCWIB:27.
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PFFtIG1 SIG. E DATE
I DATE MOVED
(425)
SIGNAIIARE
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1 771-0220
REL EDBY
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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-
OR GINAL -FILE OW INTSP/ECTO/
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 I IBC110 IT IRC110.
PINK - OWNER GOLD - ASSESSOR
10TORI PRESS HARD - YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch ............ z
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Underground .............
0 IT
R..gh.ln ................... M
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80
Commercial Final C:
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HEATING: M
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Gas: Test .................... C:
das'Plping ............ I.....
Equipment .......... 0 -n
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Commercial Final x C
M M
E)ITERIOR SHEATHING 0 —W
NAILING .......................... 0
0
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FRAMING ........................ C
ITI 0
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FIRST FLOOR FRAMING
INSULATION ...................
Floor Insulation
Wall Insulation ...........
Ceiling Insulation
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SHEETROCK NAILING
SPECIAL INSPECTION IT1
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................