20040080.pdfV
"1111FDATE �RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF-IWSINESS
'Cl MAILING ADDRE-Si�-
ul
z
0
NAME
Lu
I.- 7RESS
CITY
STATE LICENSE NUMBER
FPERMIT EXPIRES
USE PERMIT Ito /.1)
ZONE 0 (V)
NUMBER Lx/
JOB >01TE/APT#
ADDRESS A) 0a ill�'. -K---
FLAT NAME/SUBDIVISION NO LOT NO LID NO.
IF ILGIIA
11tJ
J
13UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
LID FEE $
ILSCP Approved
RW Pornia Raquilod
I El. EPHONE
EXISTING - PROPOSED
Sirriol ULa Permit Hoq'd
InspriclionROqUIlod
REQUIRE[) DEDICATION- Fr
Sidewalk Required
Undeiground
ifing required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES13 NO 13
REMARKG
OWNERICONIFIACTOFI RESPONSIBLE FOR EROSION CONJROL/DRAINAGE
ZIP I TELEPHONE
I CBL
Nua&1,0w ucr
ZIP
1:1 NEW I IV RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR AqTIVITY) EXPLAIN
LU NUMBER NUMBER OF
F
0 DWELLING
UNITS
o STORIES 1
DESCRIBE WORK TO BE DONE A
HEAT SOURCE
VA
BY
U
&PLUMBING /i,� EC
COMPLIANCE
/CHANGE OF USE
SIGN
FENCE
X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
TE DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
zi
SEPARATE PERMISSION.
cc
W PERMIT APPLICATION: 1160DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
En 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
13 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENT S FROM ANY AND
IM
ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMI1 SHALL NOT BE
-j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT IIIE INFORMATION
GIVEN IS CORRECT; AND THAT I AM TIIE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS FIEGULAIING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED Tj EREBY, NO PERSON WILL BE EMPLOYED
IL
IN VIOLATION OF THE LABOR CODE OF THVSTATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AbO RCW 18 27.
TuRiEr
10 �GE
IJE 'IGNED
ENGINEERING R
FIRE REVIEWED BY
M-
DATE
DATE
cc
Lu
z
z
E5
z
UJI
W
cc
X
VARIANCE OR CU HORELINE OR AD1111 I INSPECTION I BOND
REO'D POSTED
11YES ONO IS
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/A SIDE REAR
z
PARKING LOT AREA I PLANNING REVIEWED BY DATE' 5
REO'D I PROVIDED 0.
CHECKED BY I TYPE OF
OCCUPANT
GROUP
SPECIAL INSPECTION ]AREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REG-D
5
I M
VALUATION
Description
Plan Check
Building Permit__
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECT[(
(425) (
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due z
Receipt #
APPLICATI )ROVAL
I his application is not a permit until signed by the
Building Official or his/her Deputy. and Fees are paid, and
f yceipt is acknowledged in space ptovjded.
AC41-1 SIGNAIURVJ DATE
ASFD 13Y
ATTENTION EXT 1333 IV
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
1�
01110INAL-FILE YELLCAN. INSPECTOR
PINK -OWNER GOLD -ASSESSOR
z
0
4
0
M
--I -n
0 M
C
M C)
0
C-)
0
:E M
M Z
Cn
o -n
n
M M
0 5)
0 r-
0 M
(n
U)
M 0
Z r-
IT!
z
Cn
z
0
1711
P7-1
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch .................
0
Retaining Wall ...........
0
M
Slab Insulation ..........
=i 9
PLUMBING:
Underground .............
M
C
M 0
0
Rough -in ...................
0
0
C
Commercial Final ......
X M
M Z
HEATING:
C �z
�Gas Test ..... ...............
0)
Gas Piping .................
0 -n
Equipment .................
-n
af
Commercial Final .......
M M
Cf)
EXTERIOR SHEATHING
0 r-
0 M
NAILING ..........................
C CD
Cn
FRAMING .........................
Q 0
Z
FIRST FLOOR FRAMING...
INSULATION ...................
3:
Floor Insulation .........
z
Wall Insulation ...........
Cf)
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
c;_
OCCUPANCY ..................