20040083.pdfI
�z - DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
Y_N,AME/NAME OF BUSINF9S
M: M
AILING ADDRESS
0
CITY
ZIP TELEPHONE
NAME
U
tu
�ulj"tszi
i�
L)
Cr
U11T ZIP ITELEPHONE
14AME
0A_
ADDRESS
CITY
STATE LICENSE NUMBER
""? AVk) Y—fl) 4 11 A Z
CBL is
ZIP TELEPHONE
-fll - , -) -) -;,
61---�--) (J -e—
NEW
1:1 RESIDENTIAL
ADDITION
*COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYD
DEMOLISH
TANK
GARAGE
RETAININGWALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
0 F DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
EXPIRATION DATE
e971
oz-1-su MBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
s ( X
OTHER
FIRE SPRINKLER
FIRE ALARM
USE
ZONE
JOB
ADORES
lil z;—
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIR
-_
PERMIT
NUMEIER.,,�W
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� F1
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO
LID FEE $
TESCP Approved
13
FAW Pm.1111 Requited
13
Stioel Use Flerml Hoq*d
13
Inspection linquirad
13
Sidowalk Requited
0
Undettimund
Witing iectutrod
0
PRV REQUIRED
YES 1:1 NO 1:1
REMARKS
OWNER/CONFRAClOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVI
FIRE REVIEWED BY
D I VARIANCE OR CU
BY
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR AD6# INSPEC ON BOND
JEOP
F D POSTED
- OYES ONO IS
N AREA HEIGHT
. PROPOSED I ALLOWED , PROPOSED
C)
cc
ui
z
z
5
z
ul
W
M
rL
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
z
2
z
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REQ�D I PROVIDED
FT) I REMARKS
CHECKED BY ITYPE QF CAINSTRUCTION CO1;jE OCCUPANT
CRITICAL q7 GROUP M
AREAS SPECIAL INSPECTION JAREA OCCUPAI`JT
LOAD6////
NUMBER 11VIA REQUIRED [] YES
REMARKS
]PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
9
LOT SLOPE %
I PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
2
_j SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180 DAYS
c
Lu
j
L PERK41T LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
CCUL SEE BACK OF PINK PERMIT FOR MORE INFORMATION
I m 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
U)
W IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECT LY
FROM I HE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY RFQUIREMENI OF ANY CITY ORDINANCE
0 NOR I imi r IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ TIIIS APPLICATION, THAT THE INFORMATION
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 REGULATING CONSTRUC-
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
WOnKMEN'S COM PENSATIO441`46 U RANCE AND RCW IB 27.
DATE SIGNED
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
0TENTION E)ff 131�r'
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
091,03 PRESS HARD -YOU ARE MAKING 4 CO
FEE Description FEE
State Surcharge
City Surcharge
Base Fee e
i � _�
Plan Chk. Deposit
Receipt H
Total Amt. Due
Receipt#
............. A�
APPLICATION APPROVAL
I hisapplication is not a permit until signed by The
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DAT E
RFI.EASFD 13Y
A DATE
LA-1 �41%j� �' �__ I 1 4'- 1 1
ORIGINAL FILE YELAV -_INSPFC1C
PINK -OWNER GOLD -ASSESSOR
M
z
0
I
0
M
—i -n
Cn
0 M
c::
M 0
0
--I (-)
0 C:
M
M z
o -n
n
M M
0
0
0 M
C: cl)
9 Cn
M 0
Z r-
M
X
z
W
z
0
A
0
M
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ........... 0
I
Slab Insulation .......... M
PLUMBING:
Underground ............. r
C M
Rough -In ................... M 0
0
-40
Commercial Final ...... 0 C
--j
HEATING: X M
M Z
Gas Test .................... j,-) -4
C —
z
Gas Piping .................
Cn
Equipment ................. 0 -n
-n
Commercial Final .......
EXTERIOR SHEATHING M M
NAILING .......................... 00)
0
0 M
FRAMING ........................ C Cn
C/)
M 0
FIRST FLOOR FRAMING... Z
--I
INSULATION ................... ;U
--I
Floor Insulation .........
>
Wall Insulation ........... z
Ceiling Insulation ....... Cn
z
SHEETROCK NAILING ... 0
--I
SPECIAL INSPECTION 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................