20040021.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE N U M 13 E 0
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/i OF BUSINESS Pi NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
A r MAILING ADDRESS I ESCIP Approved
E3
E31
p C3
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V Perm
z P t"I tl,-, RIGHT OF WAY PER OFFICIAL STREET MAP i Permit Required E3
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Sweet Use ii it Roq'd [3
2- -3 inspection Required 13
EXIS11i - PROPOSED Sidewalk Required 113
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CITY ZIP I F1 F Pi "7 underground I
c-li RFOUIRFD DEJ)JCATION� FT wiring required 133
ME ER SIZE I RV REQUIRED z
NO. OF FIXTUREE P a
NAME YES NO R
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CITY ONE
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ADDRES &
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INSPECTION BOND
SHORELINE OR ADBN I
01 I-XV, (le VARIANCE OR CU D
rxplq,fv TE GlIECKE BY R.EQ'D POSTED
STATE LICENSE NUMB El 'TIN [A OYES ONO S
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SEPA REVIEW SIGN AREA HEIGHT
P�H iownF r --- 7 �A COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
PROPERTY TAX ACT i No
EXP
LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (Fr.)
PLUMBIN ECH FRONT SIDE REAR FRONT UR SIDE REAR 0
NEW VZESIDENTIAL ALLOWED PROPOSED
COMPLIANCEOR z
EADDITION COMMERCIAL PARKING LOT AREA PLANNING REVIEWED BY DATE CL
l CHANGE OF USE
REMODEL MULTIFAMILY SIGN Ri PROVIDED
GRADING Ei FENCE
0 X FT) REMARKS
REPAIR CYDS I
OTHER
DEMOLISH 0 TANK 11
GARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY El FIRE ALARM
PE OF USE, BUSI
(TYPE OF USE, BUSINESS OR IVI PLAIN: PE OF S lip E OCCUPANT
CHECKED BY TY GROUP
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0 OF DWELLING AREAS LOAD
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0 STORIES UNITS NUMBE REQUIRED
DESCRIBE WORK TO BE DONE REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D Ei
A S
ow VALUATION
$
E Description FEE
State Surcharge
H SCUIR GI G % Building Permit City Surcharge 1,.5
VESTED DATE Plumbing Base Fee 00
PLAN CHECK NO:
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVEnsWORKTO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 100 DAYS
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PERMIT LIMIT. 1 YEAR - PROVIDED WORK 15 STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, 111i ASSIGNS AND SUCCUSORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND i HARMLESS IfIF CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY ANO Fire Inspection Receipt 9
W OR DAMAGES OF WHATEVER NATURE. ARISING DIRECIIYOR INDIRECIty
4 ALL CLAIMS F Mir. ISSUANCE OF THIS PFRMII Si I NOT BE Landscape Insp. Total Amt. Due
x FROM THE ISSUANCE OF THIS PER Lys
a DEEMED TO i WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCF
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recoroing Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOi THAT THE INFORMATION APPLICATION APPROVAL'
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF jjjj5,jppiicaiton is not a pefflnit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Ruildilig official or i Deputy and Fees are paid, and
NO PERSON WIT I BE EMPt OYEO tccLjpj is acknowledged in space provided
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. REIATING TO FOR INSPECTION
IN VIOLATION OF TIIE LABOR CODE OF THE STATE OF WASHINGTON DATE
WORKMEN'S COMPENSATION INSURANCE AND FICW W 27 OF 'I I If SIGNAr F
IN U E 0 NER DATE SIGNED (425) &Ak�
it 771-0220 RFI 7ASFD fly DATE
EN ION EXT 1333
ITI\ NLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL.
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A GERTIFI 0JAIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
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PLUMBING:
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Underground .............
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Rough -In ...................
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0 0
Commercial Final ......
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HEATING:
M Z
Gas Test ....................
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Gas Piping .................
3:
Equipment .................
0 -n
-n
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Commercial Final .......
x
M 171
EXTERIOR SHEATHING
0 v;
NAILING ..........................
0 r-
0 M
FRAMING ........................
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ITI 0
FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
3:
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Wall Insulation ...........
Ceiling Insulation .......
cn
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SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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