20030968.pdfDATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
54eP&,j,5 Pqyj:oh
MAILING ADDRESS
73;L,o DJeL4-AvP,
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
NAME
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ADDRESS
1 ?:1.3/ 716-
CITY
ZIP I TELEPHONE
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ZIP
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STATE LICENSE NUMBER
PE F_ & f=1 I
PROPERTY TAX ACCOUNT PARCEL NO.
15
I PERMIT EXPIRES
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USE PERMIT
ZONE &/ NUMBER
JOB
SUITE/APT#
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PLAT NAME/SUBDIVISION NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
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Street Use Permit Req'.
EXISTING — PROPOSED--
Inspection Required 13
Sidewalk Required 0
REQUIRED DEDICATION— FT
Urwletground
Wirtngisquired 13
METER SIZE
LINE
OF FIXTURES
PRV REQUIRED
YES13 NO 13
15
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL # I
10 6�C 9 —ENGINEERING
DATE
FIR REV ED B
DATE ul
TELEPHONE
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VArNCEORCUJf
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INSPECTION
BOND
EXPIRATIONDATE
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REO'D
POSTED
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SEPA REVIEW
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SIGN AREA
HEIGHT
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ALLOWED PROPOSED
ALLOWED PROPOSED
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FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
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PROPOSED
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REO'D
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REMARKS
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NEW
RESIDENTIAL PLUMBING / ME
0 ADDITION
OMMERCIAL COMPLIANCE 0
CHANGE OF US
REMODEL
MULTIFAMILY SIGN
REPAIR
GRADING
CYDS
FENCE X
rl DEMOLISH
TANK
OTHER
[3 GARAGE
[3 RETAININGWALL
RE SPRINKLE
CARPORT
ROCKERY
ALARM
eg�IRE
UWE OF USE. BUSINESS OR ACTPATY) EXPLAIN:
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NUMBER
OF
NUMBER OF
DWELLING
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AREAS
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NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK No. VESTED DATE
#7
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBILIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT UMM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANYWAY THE CITYS, BILITY 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 S rATE 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 COMPENSATIO!�J�URANCE AND RCW 18.27.
81 T (OWNER OR)( DATE SIGNED
2EN7n\
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CHECKED BY ITCYP9 OF CONSTRUCTION UE�
GROUP
SPECIAL. INSPECTION JAREA OCCUPANT
REQUIRED [3 YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REG-0
Description
FEE
Descriptlon
D 8"
FEE
Plan Check
Surcharge
Building Permit
7_4
fState
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
—[Receipt
III
CALL
FOR INSPECTION
1A0
%-125)
771-0220
APPLICATION APPROVAL
This application 15 not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt Is acknowledged In space provided.
OFF A D�TE
RELEASED BY 'DATf
ATTE14TIO14 M 133
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL I /
W/o
, Yf ,
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL -FILE - YLLOW -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
FINAL PROJECT APPROVAL FORM
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RE -INSPECTED OUTSTANDING ISSUES GRANT FINAL PROJECT APPROVAL
DatcL_ Sign,---
ocaprvl.doc.l:tenip:bldg:fonnsIO/OI
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wal I . . . . . . . . . . . . . . . . . . . . . .
Pier/Porch ............
Retaining Wall ............
Stab Insulation ...........
PLUMBING:
Underground.............
Rough -In ....................
Commercial Final ...... .
H EATING:
Gas,76st ....................
Gas Piping .................
Equiprnpnt . ................. .
C6rhmibrclal, Final
EXTERIOR SHEATHING
NAILING ..........................
FRAMING .....................
FIRST FLOOR FRAMING...
INSULATION ............ .......
Floor Insulation
im
.,Wall Insulation ...........
Ceiling Insulation .......
SHEETR.00K NAILING ...
SPECIAL INSPECTION ...
MISCE LLANEOUS ..........
FINAL APPROVAL FOR
MS
OCCUPANCY .................
DATE hECeivib
LPER�MITEXPIRES
USE PERMIT
f% r% f%lkl C_% ZONE
F_ 111VII &j NUMBER62SV,//
JOB sunVAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS C1110
54epe,14 P4,V,'1,wAj Age+-r"hK4,A(etAf0/09V PLAT NAME/SUBDIVISION N77 LOT NO. LID NO.
MAILING ADDRESS LID FEE $
TESCP APP"r"O
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PerrrA Required
73;1,0 �OeLbf4vv, '�AV- Street Use Permit Wd
CITY Inspectim Required
ZIP TELEPHONE EXISTING — PROPOSED 9
9 fol.A0 I
NAME
ADDRESS
CITY ZIP ITELEPHONE
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ADDRESS 1
17:01 3 f6f A__bL -.4 1.,
TELEPHONE
Ly 6 34;ti —4-;
CnY(.A) ZIP
STATE LICENSE NUMBER EXPIRATION DAI
V
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PROBERTY TAX ACCOUNT PARCEL NO.
NEW�
I , . [:] RESIDENTIAL
'
ADDITI��
')4COMMERCIAL
REMOD EL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
oGARAGE
CARPORT
o RETAININGWALL
ROCKERY
OWE OF USE, BU
OR ACTIVITY) EXPLAIN:
NUMBER
OF
F
I n�n'o
.
STORIES
DESCFU13E WORK TO BE DONE
HEAT SOURCE G
PLAN CHECK HO.!, A-� -010
Side". MqU
REQUIRED DEDICATION— FT underground
Wiringrequirod [3
METER SIZE LINE SIZE I NO. OF FIXTURES PRV REQUIRED
I I YES 13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
CBL #
0 ENGINEERING REVIEWED BY DATE
FIII(RE%06*ED Bf DATE
/144—C 17, (b -S
—�1-74p_q 42
VrNCE OR CU I SHO"IlEELINEORADBif INSPECTION BOND
K V, REO'D POSTED
13YEs ONO
ZR SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED , PROP08ED
EXP I
PLUMBING/MECH I LOT COVERAGE REQUIRED SETBACKS t I PROPOSED BEIBACKS % I
!COMPLIANCE OR ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
CHANGE OF USE
PARKING DATE
0 SIGN REQ`D I PROVIlft low
o FENCE id
X FT) REMARKS %0VIVII
OTHER
D�,FIRE SPRINKLER
IRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBUC
D0&WN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
PERMIT LIMM I YEAR - PROVIDED WORIVIVOTMED WITHIN 180DAYS
SEE BACK OF PINK PERMIT FOR PADRE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HEB SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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 CORRECr ANQ 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 COMPENSATIO
."RANCE AND RCW 18.27.
E (OWNER ORAQFNVf� DATE SIGNED
CHECKED BY IV CL
AP OF CONSTRUCTIO ULAAWAN I
v�xz;-mm- 12 GROUP --r=:>
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REaD
VALUAnON
'A.2m -.0
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Mechanical
Grading
Engr. Review
A
Q V r. Inspection
Fire Review
Plan Chk. Depos 7Xb
Fire Inspection
Receipt N
00— �A)e A
Landscapoinsp.
Total Amt. Due
Recording Fee
Receipt #
F
CALL
FOR INSPECTION
1425)
771-0220
APPLICATION APPROVAL
This application 15 not a permit until signed by the
Building Official or hIs1her Deputy: and Fees are paid, and
receipt Is arknomModged In space provided.
OF IA DATE
RELEASED BY UAIA:- J
ATTENTION EXT 1333
A9
�,4/47
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 11 1 "
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
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