20040072.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME.Q4ZUSINESS
WLINIJ ADDRESS
-:03
CITY
ZIP TELEPHONE
NAME
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ICITY
ZIP TELEIIIONE
NAME
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STATE LICENSE NUMBER EXPIRAfION DATE
WA�HIQ9-7/6_6 qh_16V
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PROPERTY TAX ACCOUNT PARCEL NO.
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2, -3
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
0 GRADING CYDS
DEMOLISH
11 TANK
GARAGE
CARPORT
RETAINING WALL
11 FLOCKERY
(TYPE OF USE, BUSINESS OR ACTIV EXPLAIN:
U)
III
0
NUMBER
NUMBER OF
M
OF
DWELLING
0
STORIES
UNITS
DESCRIBE WORK TO BE DONE 7—
LA
PLUMBING / MECH
oCOMPLIANCE
OR
CHANGE OF USE
SIGN
FENCE
( X FT)
FIIIIIII
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
USE
ZONE
JOB
ADDRESS
L PERMIT EXPIRES
PERMIT '7
NUMBER
SUITE/APT#
-_ 3 /0 114 k 7�__ 1161i�� /I
PLAT NAME"SUBDIVISION NO. LOT NO. LID NO.
I LID FEE $
PUBLIC RIGIR' OF WAY PER OFFICIAL STREET MAP I ESGP Approved
F1W Polmll Raquired 13
strool Uso Potmit Hoq'd 13
EXISTING . PROPOSED inspection Haquired 13
SidflWalh ROqUifod Cl
REQUIRED DEDICATION. FT Undinground
Wiring raquirod 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
�1 I YESIJ NO 0
REMARKS
OWNER/CONIFIACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINE
STIPP W12'"S' I N "I, ME "M vil M,
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CiV Code. ECDC 19.30,020 (C) DATE
FIRE REVIEWED BY
VARIANCE OR CU
SEPIA REVIEW
COMPLETE EXEMPT
EXP
DATE
SHORELINE OR ADI3# I INSPECTION P101OND
REO'D SITED
11YES ONO S
GN AREA HEIGHT
FA L L 0 WSED , PROPOSED I ALLOWED . PROPOSED
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LOT COVE GE nE RED SETBACKS (FF.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FQFIUO'NT SIDE REAR FRONT L/RSIDE REAR
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LOT AR REVIEWED BY DATE 5
PROVII ED a.
REMARKS
OCCUPANT
GROUP
SPECIAL INS�PECTION AREA OCCUPANT
REOUIREDE] S
I YES LOAD
: :: _ 1= 11
kRENI ; RKs
A
P 0 ESS I SP
RO:GRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D
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CHECKEDBY ITYPEOF
u4I:_j U [�zj VALUATION
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Description FE6 Description FEE
HEAT P%PC GLAZING % I OT SLOPE % Plan Check State Surcharge
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. Mechanical
THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:1 Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT, 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) 'APPLICANF, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESOHS Fire Review
Plan Chk. Deposit
IN INI ERES1, AGREES To INDEMNIFY, DEFEND AND HOLD IIARMi Ess mE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
a:
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URF, ARISING DIREC TtY OR INDIREC HY Receipt 0
FROM THE ISSUANCE OF 1HIS PERMIT ISSUANCIF OF 1HIS PERMIT SHALL NOT BF
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT 111E INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER I AGREE TO COMPLY WRIT CITY AND STATE LAWS HEGULArING CONSIRLIC
TION, AND IN DOING nIE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL I his application is noi a pelinit jintil Signed by Ltic
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION Bedding Official of his/lipr Deputy and Fees are Paid, and
WORKMEN'S COMPENSA WcelPt is acknowledged If, Space plovided
!J�ANSURANCE AND FICW 18.27
SIGNATURE OWNER AG N ICIAI S
(425) SICNAi
Z_
771-0220
AT_rENTION __Z7_ FA3rI1 BY
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL EXT 13
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 ORIGINAL -FILE YELLOW INSPEcroR
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES PINK-OV.NER GOLD ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS'; ...................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
Retaining Wall ...........
0
--i
0
Slab Insulation ..........
M
PLUMBING:
=n
Underground .............
--I
3:
M
C
Rough -in ...................
M 0
0
Commercial Final ......
0
0 C
--I
HEATING:
3: M
M Z
jo --I
GasTest ....................
C z
r-
Gas Piping .................
3:
Equipment .................
0 -n
_n
Commercial Final .......
3:9
EXTERIOR SHEATHING
M M
NAILING ..........................
0
0 M
FRAMING ........................
C 0)
F. Cl)
FIRST FLOOR FRAMING ...
Q 0
Z
INSULATION ...................
;U
Floor Insulation .........
x
Wall Insulation ...........
z
Ceiling Insulation .......
C/)
z
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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