20030084.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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IPERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB ITE/APT
ADDR!2j'�w 'v & 11-'& op"',
PLAT NAMEISUBDIVISION NO.
"LOT NO."
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP APPr0v6d
RW Po'mlt Required
Street Use Peffnit Req'd
EXISTING - PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION- FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES P( NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
_;WRIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
REO'D POSTED
i13YEs 13NO $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED.
EXP LOT COVERAGE I REQUIRED SETBACKS ( ) PROPOSED SETBACKS (Fr.)
NEW SIDENTIAL V-PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
0 ADDITION YCO" MMERCIAL CHANGE OF USE I z
PARKING LOT AREA PLANNING REVIEWED BY DATE 9
9L
REMODEL MULTIFAMILY U SIGN
REOD I PROVIDED
REPAIR GRADING FENCE
CYDS ( X FT)
REMARKS
DEMOLISH 1:3 TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROOKERY FIRE ALARM
UWM,USE. BUSINESS OR A ' III:
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CHECKED BY I TYPE OF 0
N CODE OCCUPANT
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NUMBE/I _B6W / I ItRITICAL
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OF DWEWL AREAS
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SPECIAL INSPECTION AREA
OCCUPANT
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STO IES UNITS NUMBER
REQUIRED [] YES
LOAD
DENRIBE WORK TO E DONEj
REMARKS
PROGRESS INSPECTIONS PER UBC I 00/1711NAL INSPECTION REO'D
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VALUATION
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Description
FEE Description FEE
Plan Check
1
State Surcharge
LOT SLOPE %
1,
Building Permit
1. 6_�
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. AM CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMITAPPUCATION: ISO DAYS
PERMIT LIMM I YEAR - PROVIDED WORK 15 STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
NOR LIMIT IN ANY WAY THE CITYS
Recording Fee
Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
AMICATIO PROVAL
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-
CALL
This application Is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR_GgDE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
Building Official or hisfhar Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
WORKMEN'S COMPrNSATPN-Q&U`yNCE AND RCW 10.27.
OF C11 IGNrAT DA
NAT (OWNER OR GENT) DATE SIGNED
(4-25)
WA
)_3
771-0220
REL16SED BY I IDAT
kTTgNti6W
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OR�G M FILE YELLOW - IN ECTC
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 P N NER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR
DATE *APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
alriln� Wall ...........
Ret9
Slab Insulation ......
I P m
CU 'BING:
Undergrpu�pd .............
X
Rough -In ..............
Commercial Final ......
HEATING:
GT ...............
as est .....
Gas, Piping ....... :
Equipment
c6m i6l,
me al!Final
EXTERIOR SHEATHING
:.NAILING ...................
F M .............
ING� ....
R FRAM1,ING....'
FIRSTfLOO.
INSULATION
Floor Insulation .........
Wall Insulation ..............
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
yv�
OCCUPANCY ..................
W4
V�TE RECEIVED
PERMIT EXPIRES
SE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUC ION PERMI APPLICATION JOB CL'S_ 4�414,t_GUITEVAPT#
ADDRESS
07MZE NA�01`
BUSI
ga
7S
PLAT NAME/SUBDIVISION N
LID NO.
M ADD
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
1ESCF' APPI-ed
Aw '."" R'i
:292 U
. Street Use Penrift Rei
UTY, ZIP
iELEPHONE
EXISTING — PROPOSED
Ini Required
Required
Skjoi
L
REQUIRED DEDICATION— FT
I Uriderground
912
JA (a z29 - i /.
lwmgfoq ed 13
.2
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
133
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-15
YESA NO 13
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ADDRES
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
AS
ZIP ITIfLEPHONE
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ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE
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Ir6N UMBER EXPIRATION D TE
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
REO'D POSTED
�CKU�61Y
13YEs 13NO $
0 1 //'C�
SWA REVIEW SIGN AREA HEIGHT
-COUNT PARUL NO.
COMPLIFTE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
I , ,
EXP
NEW M RAIDENTIAL aKLUMBING f MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
COMPLIANCE OR
ADDITION YCOMMERCIAL
CHANGE OF USE
1: 1 REMODEL 0 MULTIFAMILY SIGN
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REPAIR GRADING FENCE
CYDS X FT)
REMARKS
0 DEMOLISH TANK OTHER
o GARAGE 0 RETAININGWALL E] FIRE SPRINKLER
--CARPOPT ROCKERY FIRE ALARM
(TYPE OF USE, BU INESS OR A EXPLAi
CHECKED BY!jTYPE OF CONSTRUCTION CODE OCCUPANT
GROUP
q
NUMBEI 'FUMBER Qf/ /-I _ORITICA�
104
LL
,OF UNIT LINJV AREAS
DWEL
STORIES NUMBER
SPECIAL INSPECTION JAREA CUPANT
REQUIRED LOAD
[],VF S
0 IBE WaK TO BE DO
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REMARKS
ii 4
PROGRESS INSPECTIONS PER UBC 108MINAL INSPECTION RE12D
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Description FEE Description FEE
.j
Plan Check
State Surcharge
HEAT SOIJACE 0 ING,.% LOT SLOPE %
Building Permit City Surcharge
t
PLAN CHECK NO: VESTED DATE
Plumbing
M
Mechanical
THIS PERMIT AUTHOR17ES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPEEM ONLX ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRMVAYS, MARQUEES, ETC.) WILLREQUIRE
SEPARATE PERMISSION.
Engr. Reviihv
PERMIT APPILICATION: 1150DAYS
PERMIT IUMM I YEAR - PROVIDED WORK IS START M- WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERM11f FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CRYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION AP
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-
This applicaUon Is not a permit until signed by the
CALL
TION; AND IN GOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPILOYED
Building Official or his1her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOWINSPECTION receipt Is acknowledged In space provided.
WORKMEN'S COMPENSATION INSUFlii AND RCW 18.27.
OFFICIALS S GNA7TU E DATE
OWNER OR DATE SIGNED
IA05)
77,71
1. V; A
1z I
771-02: 20 —PATE
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ZdAgEC(Si'll
AffEffiddlky
EXT 1333'
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
T
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
X)R�GIIJAL FILE YELLOW ll�S�CT�R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
3S S,
P Ni� �-NER GOLD -ASS SSOR
04/02 GREEN - ACCOUNTING
PRESS HARD -YOU ARE MAKING 5 COPIES
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