20040049.pdfIVED [PERMIT EXPIRES
USE PERMIT
ZONE
CITY OF EDMONDS NUMBER
7 JOB I E/APT#
CONSTRUCTION PERMIT APPLICATION I ADDRESS
OWNER NAMEINAME OF BUSINESS A
PLAT NAME/SUBDIVISION NO. LOT NO. 7 LID r4O
MAILING ADDRESS LID FEE
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z TFSCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
14t6 4�IL06 q� Street Use Permit Roq'd 0
CITY ZIP TELEPHONE EXISTING — PROPOSED— Inspection RoquiFed 13
sidewalk Required 0
REQUIRED DEDICATION— FT Underground
Y�_6� 20 Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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YES El NO rr
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L- ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
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CITY ZIP TELEPHONE
NAME CBLft
ENGINEERING REVIEWED BY DATE
iff)teli� ILL,
ADDRESS
01
Easr /4�f!, A L r-0, IC�Ag� FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE
0 0
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2 � 72 VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STAtf LICENSE NUMBER P0 C EXPIRATION DATE CHECKED BY I REO'D POSTED
OYES ONO S
SIGN AREA HEIGH
SEPA REVIEW
PROPERTY TAX A OUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
+ r-V�)
UJI 9 611)1-1 �30'7 CA-J
EXP
LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (FT.)
F-1 NEW RESIDENTIAL PLUMBING i MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
GRADING FENCE
REPAIR 1:1 CYDS ( x FT) REMARKS
DEMOLISH 17 TANK El OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT 1:1 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR.ACTIVITY) EXPLAIN:
L CHECKED By TYPE OF CONSTRU�TION CODD OCCUPANTM
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U) PILP 0
IU14BER OF CRITICAL
OF iWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER 01NITS NUMBER 0�plr REQUIRED [] LOAD
0 STORIES tu YES
DESCRIBE WORK TO BE DONE
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ARKS
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CHECKED By
SPECIAL I N SP EC
REO In ED
REMARKS z
PROGRESS INSPECTIONS PER UBC 1013/FINAL INSPECTION REO'D Ej
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit city Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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: 180DAYS
LU
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
U) 'APPLICANT, ON BEHALF OF HIS on HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECHY OR INDIRECHY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL Nor 13F C
MODIFX WAIVE OR REDUCE ANY REQUIREMENI OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
DEEMED TO
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Recording Fee Receipt III It/
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 REGULAIING CONSTRUC. CALL This application is not a pLitnit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL. BE EMPLOYED Iluilchug 011icial or his/her Deputy: and Fees are paid, and
IN V;6LATION OF T14E LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIOI� INS.QRANCE AND RCW 18,27, OFFICW.S SIGNATURE I DATEi
si TURE (OWNER OR ENT DATE SIGNED (425)
0�j -0220 lk_(
771 RqITASFD BY DATt
ATTENTION E)ff 1333 V
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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
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 .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
N(VU
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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