20030528.pdfI
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DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY
ZIP ITELEPIiONE
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USE PERMIT
Z ONE
Z NUMBER
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1tAODDRESS
PLAT NAME/SUBDIVISION NO NO. LID NO.
LID FEE S
7ESCP APP(Ov@d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW parrrJl Required
Street Use Pennit Reqi'd
EXISTING - PROPOSED
inspection Required
Sidewalk Required 13
REQUIRED DEDICATION- FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
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YES 13 NO 13 z
REMARKS
OWNEFIXONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME
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ENGINEERING REVIEWED BY DATE
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ADDRESS
9116 2,24
Fl E REVIEWED BY DATE W
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CITY ZIP
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TELEPHONE
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VARIANCE OR CU
SHORELINE OR ADBN
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INSPECTION
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13YES 0�0
BOND
POSTED
1$ -
STATE LICENSE NUMBER EXPIRATION DATE
SEPA REVIEW
COMPLETE , EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
1% HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
7
X—NEW 297-PLUMBING'Zo
COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
REMODEL MULTIFAMILY SIGN
REPAIR GRADING CYDS o FENCE X FT)
DEMOLISH TANK OTHER
[3GARAGE RETAININGWALL o FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSED
A44 ch
REQUIRED SETBACKS (FT.)
FRONT SIDE REAR
PROPOSED SETBACKS (FT)
FRONT URSIDE REAR
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PARKING LOVAREA
I PLANNING REVIEWED BY DATE
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(TYPE OF USE, BUSINESS OR ACTN7M EXPLAIN:
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CHECKED BY
ITYPEM
12M
-GROUP
OCCUPANT
NUMBER
OF
STORIES
NUMBER OF
DWELLING
UNITS
AREAS
NUMBER
...
SPECIAL INSPECTION JAREA
REQUIRED [] YES
OCCUPANT
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-0
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VALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE
GLAZING %
LOT SLOPE %
Building Permit
City Surcharge
Plumbing
PLAN CHECK NP
VESTED DATE
an — 4-=
Mechanical
410
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
-
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
Grading
I -) WILL REQUIRE
3 DOMAIN (CURSS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC
SEPARATE PERMISSION.
Engr. Review
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5 PERMIT APPILJCATION: 180 DAYS
L PERMIT LIMIT! 1 YEAR -PROVIDED WORK IS VrARTED WITHIN 1180DAYS
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
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Total Amt. Due
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITTS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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Recording Fee
Receipt III
7,
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION
APPROVAL
GIVEN IS CORREC-P 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
Building Official or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE 9TATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE A�^W 18.27.
1 GNATUPJ ATE
S,
DATE SIGNED
(425)
715 03
771-0220
OAT
RELEASED f DATEr
ENTIOW
EXT 1333
7 14
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL - ILE - ELLOW -�INSPECTOFI
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - OW --- - 0101 n - 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 .................
Retaining Wall ...........
.*ab.Insulation .1 .........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final -
HEATING:.'
Gas Test ............... I
Gas Piping ...... ..........
.4
Equipment ................
Ni�
Commercial Final
EXTERIOR SHEATHING
NAILING: ..........................
FRAMING .........................
FIRST FLOOR FRAMING...
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INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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DATE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Alllaf4r-L (2-oli-.577-s
MAILING ADDRESS
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CITY ZIP TELEPHONE
NAME
ADDRESS
CITY ZIP ITELEPHONE
)0 IT EXPIRES //Z
USE RMIT
ZONE PE
NUMBER &�2 3 -
JOB SUITE/APT#
ADDRESS
PLAT NAME/SUBDiVISION NO.
LOT NO
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW P,:,=,
Street Use Perntit Reqd
EXISTING — PROPOSED
InspecUo" Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE ;;;TTNO.
OF FIXTURES
PRV REQUIRED
YES 13 NO 13 z
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE,
NAME
M r-TAIsmrrds
CBL#
ENGINEERING REVIEWED BY
DATE
11
ADDRESS
9//,/ - 2,24
FIRE REVIEWED BY
DATE
Lu
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CITY ZIP
M47-
TELEPHONE
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VARIANCE OR CUl
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SHORELINE OR ADIM
Al&,-t gr4Qb 113YES^O
INSPECTION
REOP.,00
BOND
POSTED
1$ —
STATE LICENSE NUMBER EXPIRATION
MQA Lr v C 6
DATE
C)19CKED BY
SEPA REVIEW
COMPLETE , EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED �
' HEIGHT
ALLOWED PROPOSED
PROPERTY TAX ACCOUNT PARCEL NO.
AVEW B"RESIDENTIAL
0. ADDITION 0 COMMERCIAL
0 REMODEL MULTIFAMILY
0 REPAIR 0 GRADING
CYDS
0 DEMOLISH 0 TA14K
oGARAGE I RETAININGWALL
CARPORT 0 ROCKERY
A-PLUMBING'a
COMPLIANCE OR
0 CHANGE OF USE
0 SIGN
0 FENCE X
( Fr)
0 OTHER
FIRE SPRINKLER
0 FIRE ALARM
LOT COVERAGE
ALLOWED PROPOSED
&ct chA)i
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
CIA— -
PROPOSED SETBACKS (FTj
FRONT L/RSIDE REAR
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PARKING L7AREA
REO'D PROVIDED
I PLANNING REVIEWED BY DATE
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(TYPE OF -USE. BUSINESS OR ACTIVITY)i EXPLAIN:
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CHECKED BY
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OCCUP
GROUPANT
oe
DUMBE
NUMBER N R OF
OF WELLING 4.
STORIES UNITS
DESCRIBE WORK TO BE DONE
Lc XT&Ac�,r- g N)4)4
CRITICAL
AREAS
NUMBER
as-r
__ITYP:MO -OCCUPANT
SPECIAL INSPECTION JAREA
REQUIRED 0 S
YE
LOAD
REMARKS
INISPECTIONS PER UBC 1108/FINAL INSPECTION REaD
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VALUAnON
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Description
FEE
Description
FEE
Plan Check
I
State Surcharge I
HEAT SOURCE
GLAZING %
FBuilding
LOT SLOPE %
Permit
City Surcharge
5
PLAN CHEC
VESTED DATE
Plumbing
L%.4
Mechanical
THIS PERMrr AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
0 E DOME ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
R
DOMAIN (CURBS, SIDEWALKS, DRIVIEVAYS, MARQUEES, ETC.) WILL REQUI E
3
Engr. Review
SEPARATE PERMISSION.
1
5 PEnMiTAPPUCATION: ISO DAYS
L PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WrTHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFX 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
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Landscapelnsp.
Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CnYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
E
Recording Fee
Receipt #
I HEREBY 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
Building official or his/her Deputy; and Foos are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE E OF WASHINGTON RELATING TO
FOR INSPECTION
receipt Is acknowledged in space provided.
WORKMERS COMPENSATION INSgR8,NCE AN CW 18.27.
FFICI GNA U 6ATE
SIQUAW01WHOVVE OR AGENT) DATE SIGNED
(42�5)
I
771-0220
RELEA D Y DATE'
77TENTIO4
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-
ORIGINAL - tl!! I OW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
PINK - CMfb GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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