20040033.pdfk.;
DATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNTRNAME/NAME OF BUSIN
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MAILING ADDRESS
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CITY \,—)Zip TE LEPHONE
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NAME oo,
ADDRESS
CITY
ZIP ITELEPHONE
USE
ZONE
JOB
ADDRFQ-
PLAT NAM EISU BDIVI SION NO,
PERMIT EXPIRES
PERMIT
N U M B E R
LOT
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
SUITFIAPTH
LID NO.
LID FEE S
TESCP Approved
Rw Permit Required
Street Use Permit Roq'd
E3
Inspection Required
13
Sidewalk Required
[3
Underground
Wiring required
0
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
NAME
CBLO
DATE
ENGINEERING REVIEWED BY
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ADDRESS
C
FIRE REVIEWED BY
DATE
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CIT ZIP
TELEPHONE
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VARIANCE OR CU
SHORELINEORADB#
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INSPECTION
REO'D
BOND
POSTED
STATE LICENSE NUMBER EXPIRAIION DATE
CHECKED BY
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ow
OYES Min
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SEPA REVIEW
COMPLETE EXEMPT
SIGN AREA
ALLOWED PROPOSED\
HEIGHT
ALLOWED PROPOSED
PROPERTY TXX ACCOUNT �AIVEL NO.
*0 eF3 :ZL -7 C) -7
EXP ,
7�1
El NEW RESIDENTIAL 11 PLUMBING MECH
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED liETBACKS (FT.)
FRONT SIDE REAR
NOPOSED SET13ACKS (Fr.)
FRONT URSIDE REAR
COMPLIANCE OR
ADDITION ERCIAL
9---COMM 1:1
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CHANGE OF USE
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PARKING
REO'D I PROVIDED
LOT AREA
PLANNING REVIEWED BY DATE
IL
MULTIFAMILY
REMODEL SIGN
FENCE
REPAIR GRADING CYDS X FT)
REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACT[VIrO EXPLAIN.
CHECKED BY
ITYPE
NsTRUC��ON
coiu
OCCUPANT
GROUP
NUM13ER
OF
NUM13ER OF
DWELLING
CRITICAL
AREAS
SPECIAL. INSPECTION
AREA
I
OCCUPANT
STORIES
UNI S
T
NUMBER
REQUIRED [:] YES
LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REGID
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VALUATION
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D escription
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURC�_T GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK 01 VESTED DATE
Plumbing
74r - 11Z)- 12
'
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS 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.
Engr. Review
rx PERMIT APPLICATION: 180 DAYS
ul
9L PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
t3 CITY OF
Fire Review
Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt # 4 ::�q -591 5�
W ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due —
15
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.4
0? 1
Recording Fee
Receipt III
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
APPLICATION AFPROVAL
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 REGULAT ING CONSTRUC-
CALL
This application is not a permit until signed by the
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
Building Official or his/her Deputy: and Foes are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFIQIALS SIGNATURE DATE
DATE S17
SIGNATURE (OWNER 011� Ej� ED
(42 5)
7,
VA tiv
771-0220
-1
REL D BY
A17EN I N
EXT 1333
A."
IT IS LIN WF L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
WF
A FINAL NS ECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
S
ORIGIN— - 61 �TOR
CATE OF CUPANCY HAS BEEN GRANTED. UBC SECTION 109
t
PINK - OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU
ARE MAKING 5 COPIES GREEN - ACCOUNTING
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1711
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
0
Retaining Wall ...........
Slab Insulation .......... M
PLUMBING: =i -n
Underground .....
M
Rough -in ................... M 0
0
-40
Commercial Final ...... 0 C
--I
X M
HEATING: M z
Gas Test .................... C:
z
>
-4
Gas Piping ................. x
C/)
Equipment ................. o -n
Commercial Final .......
M
ITI
EXTERIOR SHEATHING
NAILING ..........................
0
0 M
C
FRAMING ........................ Cn
M 0
FIRST FLOOR FRAMING ... Z
INSULATION ...................
Floor Insulation .........
>
z
Wall Insulation ...........
Ceiling Insulation ....... fn
SHEETROCK NAILING ...
0
I
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR v%1S 't
OCCUPANCY ..................
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