20030903.pdf,? DATE RECEIVED
LL 1, Ll (_A, 2_'�_ _ I N
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PW4T e�OWAVU:S L-blL.
UM MAILING ADDRESS
CITY ZIP TELEPHONE
GgAfrb�_ 1:579>1z"I I Z-bb - -t2:;5-114.
NAME
0 wf'60�'t- f+WV'GbNk
tu
t ADDRESS
x
0
cc
4
CITY ZIP I TELEPHONE
f1co. S44.5")-
a6:ndy::= dj I 9-u
NAME I CBL ti,
ADDRESS
0"t D 1 ,
CITY ZIP TELI!PHO�E
STATE LICENSE NUMBER
iXPIRATION DATE
PROPERTY TAX ACCOUNT PARCEL NO.
11 C),�52 to
601 �b
ANEW
17 RESIDENTIAL
1:1 ADDITION
COMMERCIAL
71 REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
o RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
A f I A I i �4 e7 t--- t
Lul NUM13ER NUMBER OF
0 OF DWELLING
10
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
le-1,
"fit PERMIT EXPIRES i
Z-, _'/' I I
USE PERMIT
ZONE
�,'
q
NUIMBER;�
I/
JOB
ADDRESS
SUITE/APT#
PLAT NAME,SUBDIVISION N6
LOT NO.
LID N&.'
LID FEE $
PUBLIC R194T OF WA Y PER OFFICIA L STREET M A P
I ESCP Approved
13
Street Use Permit Poqd
E3
EXISTIN6 PROPOSED
inspection Required
0
Sidnwalk Required
13
REQUIRED DEDICATION— FT
Underground
Wiring required
E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
Ift'NO 13
YES
lu
REMARKS
z
z
OWNERICON TRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE
a
z
LU
b"I '-acm C ; 't (-j I ( , , I iv f taxit:_
J,
<-� Lo-,
DAT
ENGINEERING REVIEWED BY
_2 1
FIRE REVIEWED BY DATE
cc
I E:
I I I VARIANCE OR CU SHORELINE OR ADBI I INSPECTION I BOND
CH5CKjEDBY REO'D POSTED
OYES A-0 IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE.. EXEMPT ALLOWED . PROPOSED I ALLOWED . PROPOSED
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
�AREAS
rl NUMBER
EXP V �,_
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT
LIFISIDE REAR
13
/07"
z
z
PARKING
LOT AREA
PLANNING REVIEWED BY
DATE
CL
IECI DED
I
I 4F4 1h JfAAK1S All /1 - I
HEAT SOURCE GLAZING %
PLAN CHECK NO:
LOT SLOPE %
VESTED DATE
I� /I _/ _ �z 71�_j I
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISODAYS
W
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
In -APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT 13E
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION
_.PSURANCE AND RCW 18 27.
SIGNA�dlf (OWNER OR I i DATE SIGNED
1A nh
REMARKS
� 110
Yjow7w
4—
CHE_CKED 13Y ITYPE OF ONSTRUCTION OCCUPANT
I
j GROUP J;Z�Z
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED'KY LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
Description
FEE
State Surcharge
4151'
city Surcharge
PlanChk.Deposit /&/Z")
Receipt #
Total Amt. Due
Receipt #
c9 1
APPLICATION APPROVAL
This application is not a pennit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
F X,
FICI - SIGjjT
17,RF DATE
1) 1 A k1l) / ) ?'7
RELEASED BY
A17ENTION EXT 1333,--L::
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI.
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
DA
ORIGINAL - FILE YELLCW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
V
z
0
'I
0
M
—4 -n
0 M
C
M 0
0
—1 0
0 C:
--i r.
X M
M z
JO --I
C
3:
CD
0 71
n
M M
0
0
0 M
cl)
Cn
M 0
Z r-
M
r
z
U)
z
0
I
0
171
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ........... i
0
M
Slab Insulation ..........
-n
PLUMBING:
Underground ............. M
C:
M
Rough -In ................... 0
0 C:
Commercial Final ......
M
HEATING: ITI z
Gas Test .................... C
3:
Gas Piping .................
Cl)
0 -n
Equipment ............... _n
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING .......................... 0
0 M
cl)
FRAMING ........................ C/)
M C-)
Z r
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... >
z
Wall Insulation ........... —4
Ceiling Insulation ....... C/)
z
0
SHEETROCK NAILING ... __11
0
SPECIAL INSPECTION ... 1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................