20030392.pdfDATE RECEIVED
PERMIT EXPIRES
I USE PERMIT
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CITY OF EDMONDS NUMBER,,. StFor;
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEMAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
LM MAILING ADDRESS �0
u IESCP Approved
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP BIN Permit Required 0
3: 6� f514, "D-L, /JVI� street use Permit Raq'd 13
0 ",r EXISTING PROPOSED inspection Required [3
CITY ZIP TELEPHONE Sidewalk Required 13
Underground
lei REQUIRED DEDICATION� FT wiring requiFad E3
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NAME METER SIZE LINE SIZE FI =URESPR REQUIRED
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'U &3_71 VARIANCE OR C SHORELINE OR ADBAI INSPECTION BOND
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STATE LICENSE NUMBER EXPIRATION DATE . R B IINSPECTION RE"ENNO is
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LOT COVERAGE— PROPOSED SETBACKS (FT.)
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%'A'Rg METER TO BE RE OVED Olt z
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ADDITION COMMERCIAL CHANGE OF USE ROSE 9113 1TLj AArn 's-4 z
PAR PILAINWN&VREN laf-ED DATE
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REMODEL MULTIFAMILY SIGN REO'D P AT A P] ROVED DUMP SITE ONLY
FENCE
REPAIR GRADING CYDS I X FT) REMARKS ur_r- Ut'!I40iATION INSPECTION
CHFr!Q'j,:p .4?f E;IIUI�
OTHER JOB CARD
DEMOLISH TANK K)R INSPECTION RE0U1nrKAr7Pj'rr,
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: MENRINMINNMM� 01011
TYPE OFLCONSTRILICTION coq� OCCUPAN
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w NUMBER NUMBER OF CRITICAL SPECIAL. INSPECTION JAREA OCCUPANT
0 OF DWELLING AREAS LOAD
STORIES UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D,
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VALUATION L
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SO RCE GLAZING % LOT SLOPE %
4"'; Building Permit City Surcharge
VESTED DATE Plumbing
PLAN CREQK NO: /-47
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT C04ERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
IP- Engr. Review
M PERMIT APPLICATION: 180DAYS
W
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
V) "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
X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt 0 IIA 4L., I
I HEREBY ACKNOWLEDGE THATII HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND THATI I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I I �GREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IW DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL 13E EMPLOYED Building Official or his/her Deputy: and Fees are paid. and
IN vIOLATIdN F THEILAB CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S UMPEN§if N,,I 9URANCE AND RCW 18.27. OFFIeIA
_��LIGNA E DATE
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T� DAT
(�WNER (425)
SIGNATURE.
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41GNED
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771-0220 RELEA'zED By
ATTF:N'TI'0N' EXT 1333
'21
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
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04/02 C)pl=qq WAnn V(')l I APF KA,&I<IK]r. R r.r)PIF.q GREEN - ACCOUNT11,
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall ..........................
Pier/Porch .................
'Retaining -Wall ..............
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Slab Insulation ..........
0
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PLUMBING:'
VndergKound .............
R6g`h"In ...................
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Commercial Final .......
M
0
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0
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HEATING:
3: M
Gas Test ................
M Z
C
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Gas Piping .................
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-4
Equipment .................
r—
3:
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Commercial Final .......
0 -n
EXTERIOR SHEATHING
M M
NAILING,)— .......................
0 r
FRAMING ........................
0 M
C Cn
FIRST FLOOR FRAMING...
F. Cn
Q 0
Z r—
INSULATION ...................
Floor Insulation .........
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3:
Wall Insulation ...........
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Ceiling Insulation .......
—4
SHEETROCK NAILING ...
Cn
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................