20040055.pdfDATE RECEIVED
-PLIGUIbN I J 0 2, PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLiCATION ADDRESS
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PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
tr MAILING ADDRIES'S LID FEE $
UJI TFSCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Period Finquired
0 _�Qs� \40ii\N 6+ 1 Street Use Permit Roq'd E3
EXISTING - PROPOSED inspection Required
51T TELErHqNE Sidewalk Required
4q5 I yg REQUIRED DEDICA1 ION -00000' FT Underground
�rmlp I � III XY Wiring required E3
NAME METER SIZE OF FIXTURES PRV REQUIRED
YES NO 13 z
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t: ADDRESS REMARKS z
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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U'INEERING REVIEWED By DATE
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I!K VARIANCE OR CU HORELINE OR ADBN NSPECTION BOND
STATE LICENSE NUMBER EXPIRATIIN DATE CHECKED B REO'D POSTED
EIYES��NO IS
SEPA REVIEW SIGN AREA HEIGHT
-j PROPERMT X ACCO NTPARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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NEW Ck**IESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
ALLOWED p3;OVSE FRONT SIDE REAR FRONT L/R SIDE REAR 0
COMPLIANCE OR y
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OADDITION COMMERCIAL CHANGE OF USE ?�5xo "/1 z
f'ARKING LOT AREA PLANNING REVIEWED BY DATE
,X'REMODEL MULTIFAMILY SIGN REO'D I/PVROVIDED
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GRADING FENCE
REPAIR CYDS ( x FT) REMARKS
OTHER
DEMOLISH TANK
GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT -ROCKERY FIRE ALARM
(rYPE OF USE, BUSINESS OR ACTDIIT P N: CHECKED BY TYPE CONSWUCJION C2? OCCUPANT
cc GROUP
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NUMBER NUMBER OF CRITICAL
OF DWELLIN AREAS SPECIAL INSPECTION AREA OCCUPANT
In NUMBE REQUIRED [] LOAD
0 STORIES UNITS R YES
DESCRIBE WORK TO BE DONE
REMARKS z
IF PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
v/V V) r] (I t) NALUATION
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rA'jfj� ui, State Surcharge
Plan Check
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HEAT SOURCE GLAZING % I LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK N4�) VESTED DATE
0' 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
cc PERMIT APPLICATION: 160 DAYS
W
St. PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
- Go SEE BACK OF PINK PERMIT FOR MORE INFORMATION Fire Review Plan Chk. Deposit
'APPLICANT ON BEHALF OF HIS OH HER SPOUSE. HEIRS. ASSIGNS AND SUCCESOIIS
IN INTERE�T, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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4 ALL CLAIMS FOR DAMAGES OFWHATLVER NATURE, ARISING DIRECTlY ORINDIRFCIIY
* FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
* DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY Cl FY 013DINANCE Landscapelnsp. Total Amt. Due jq
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PHOViSION'
Recording Fee Receipt 0 2 Ll ei e�
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
THEOWNER I AGREE TO COMPLY WIT 11 CITY AND STATE LAWS REGULAI ING CONSTRUC This application is riot a permit until signed by the
TION, AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy. and Fees are paid, and
IN VIOLATIONA5rwJIE LA13OR CODE OF THE STATE OF WASHINGFON RELATING TO FOR INSPECTION receipt is acknowledged in space pruvided
WORKMEN',�fO�IPE�SATION INSURANCE AND fICW 111 27. OFFICIALS SIGNATUP - DATE
S ATUR 0 AJE�T) DATE SIGNED (425)
771-0220
UIL RFt EASED 13Y DATE
ATTENTION EXT 1333 )7- 1
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 67 Z&
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
0.1,102 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall.......................... z
Pier/Porch .................
Retaining Wall ...........
Slab Insulation .......... =i TH
PLUMBING:
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Underground ............. M
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Rough -In ................... 0 C:
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Commercial Final ...... ITI Z
HEATING: C
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Gas Test ....................
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Gas Piping ................. 0 _n
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Equipment .................
Commercial Final ....... M ITI
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EXTERIOR SHEATHING 0 M
NAILING .......................... C C/)
90
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FRAMING ........................ Z r—
FIRST FLOOR FRAMING ... ;U
INSULATION ...................
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Floor Insulation .........
Wall Insulation ........... cl)
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Ceiling Insulation ....... 0
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SHEETROCK NAILING ... 0
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SPECIAL INSPECTION
MISCELLANEOUS ... ......
FINAL APPROVAL FOR,
OCCUPANCY ...................
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APPLIED IMAGE
1653 E.MAIN STREET
ROCHESTER, NY 14609
TEL (716) 482-0300
FAX (716) 288-S989
Precision JFVLAGE Products & Services
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NOTICE: IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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CERTIFICATE 0
AUTHENTICITY'l
1, the undersigned, an employee of Micro Com Systems
Ltd., do certify that the documents described on the
auideslieet fiaraet are being filmed in accordance with
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the Washinorton State Standards for -the production and
use of microfilm. I also certify that the records
contained on this roll of microfilm are true and correct
copies of the originals. However, no judgement is made
at the time of microfilming as to the validity, accuracy
or legality of any document.
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FILMED THIS Ec�-1 Y-) DAY OF
SIGNATURE:
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