20030354.pdfDATE RECEIVED
6
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMENAME OF BUSINESS
57*6 DA y"fi, 4. i-C, (PA V, D e.,Al- Y_ 7Z)
MAILING ADDRESS
132!��_goofrht)P-,VAY
CITY ZIP TELEPHONE
6-�L Le vif IF el,6005
NAME
Lefe b�e,:v�,d
ADDRESS
12-4-0,q —/06-fl� P1
_ A16-
CITY ZIP TELEPHON
/<j' Ak44+AJ49 qgel, � Puf) 6j 3 -:5-551
NAME ICBL#
�[_Ty ZIP
'Aw,�F,f ir, zAWffFf,'FAw'WAN
LICENSE NUMBER E Wt�TFj Z 3
M
NEW
RESIDENTIAL
ADDITION
OMMERCIAL
9C
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAJNINGWALL
CARPORT
ROCKERY
RPE OF USA, BUSINESS OR AC"�TM 0MA!N:
NUMBE
�UMSER 0F
OF
DWELLING
STORIEA
DESCRIBE WORK TO BE DONE
By
PLUMBING/MECHI
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
X Fr)
PERMIT EXPIRES
USE PERMIT
ZON NUMBER
JOB
E11— 50--
UITE
ADDRESS
1 C 9
PLAT NAME/SUBDIVISION NO. NO.
LID NO.
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
street us@ Parrylit Reqd
EXISTING — PROPOSED
Inspection Required
Sid&*&* Required
REQUIRED DEDICATION- FT
Undergrourid
Whing required
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
I
YESE3 NO 13 z
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
cc
IE
0 — Ot—
VARIANCE OR CU SHORELINE OR ADBNj. INSPECTION 1. BOND
PEO'D POSTED
13YEs ONO
SEPA REVIEW SIGN AREA: , HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
.XP
LOT COVERAGE REQUIRED SETBACKS (Fr.), -PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE BEAR FRONT LIRSIDE REAR
PARKING LOT AREA I PLANNING REVIEWED,IBY DATZ
RE0`D I PROVIDED
FIRE SPRINKLER
FIREALARM
A/ CHECKED BY , I —TYPE OF CONSTRUMON
fRErICAL 11� &_344
R AS SPECIAL INSPECTION AREA
W
NUMBER REQUIRED YES
JREMARKS
f
PROGRESS INSPECTIONS PER USC 108/FI
k2A.Z I
OCCUPANT
GROUP A17
OCCUPANT
LOAD
INSPECTION REG-D
Description
FEE Description FEE
I
Plan Check
State Surcharge
HEAT SOURCE GLAONG % LOT SLOPE %
I
Building Permit
City Surcharge
-
PLAN CHECK NO: VESTED DA E
Plumbing
7
LWonK
Mechanical
THIS PERMIT AUTHORUES ONLY THE WORK NOTED. THIS PERMIT C;0VEE4 TO
BE DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUC71ON ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWAUCS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
x
Engr. Review
PERMIT APPIUCATION: 180DAYS
PERMIT umrr i YEAR - PROVIDED WORK 16 STARTED WITHIN 190 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
2 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 C17Y ORDINANCE
Landscapainsp.
Total Amt. Due
NOR LIMIT IN ANY WAY THE C17YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee
Receipt #
I HERE13Y 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
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
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
rocolptis acknowledged In space provided.
WORKMENS COMPENSATIO"SURANCE AND RCW 18.27.
0 LS 81 UBE DATE
SI U"
SIGNATURE (OWNER 0 E DATE SIGNED
jAgm
1, 6"1
771-022 0
ATTENTION
EXr 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
. I . � I I I . . 1,,,, 1 . .., -i I, I I I I I I I I I
'' I I I '; .:; - I I -
r I
SETBACKS
FOUNDATIONO
Footing
9 L
I r wall
I t
Pler/Porch
1 9 d. I 1 4 1 1 i I I I I I ll I I
t
I T
Retaining Wall
It
Slab Insulation
PLUMBING.
I I I d I I l I L
I I -P 9 'r I
L I'. I q, r. i Underground
I
Rougholn
i, I
'Commercial Final
;.r -It I k
HEATING6
Gas Test
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Gas Piping
Td
d' Equipment
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Commercial Final
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EXTERIOR SHEATHING
it, I I, l;
NAILING
ltlli- I ll I I
i
l i' I L� IV P; 'I
i" .
FRAMING
I F 1Z
FIRST FLOOR FRAMING&.*
I L I
I I L4
INSULATION
Floor Insulation
I f k
Wall Insulation
I I I I I I
I d
Celljng Insulation
1 4
I I I d I NAILING
SHEETROCK
SPECIAL INSPECTION
j I
MISCELLANEOUS
I �4
FINAL AP
PROVAL FOR,
I 1, 4
OCCUPANCY
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RECORD Of INSPECTIONS
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INSPECTOR
A
DATE APPROVED
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