20040103.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Aiavi q) I -NAIL- PiGg-C-C
MAILING ADDRESS
'733 Metvt�i 4-ote,
CITY ZIP TELEPHONE
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14AME
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ADDRESS
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CITY ZIP
ITELEPHONE
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NAME.
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ZIP
TELEPHONE
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STATE LICENSE NUMBER7 EXPIRATION DATE
PROPERTY TAX ACCO= P"ARCEL NO.
I
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAININGWALL
CARPORT
ROCKERY
CrYPE OF USE, BUSINESS OR ACTIVITY) EXPPVN:
NUMBER
NUMBER OF
OF
DWELLING
STORIES
UNITS
DESCRIBE WORK TO BE DONE
AlI IJ(4*) rUQ f.1,tV64S
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load I it /7 44-
HEAT SOURCE
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PLUMBING / MECH
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COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
( x Fr,
OTHER
FIRE SPRINKLER
FIRE ALARM
& " I
4.1f/
GLAZING %
CRITICAL
AREAS
NUMBER
d
-4
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPI ICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. I IS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALI- CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIYOR INDIRECTLY
FROM THE ISSUANCE OF IHIS PERMIT. ISSUANCE OF IHIS PERMIT SHALT- NOT- BE
DEEMEDTO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT THE INFORMATION
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THEOWNER 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
WORKMEN'S,GOMPE I NSATION INSURANCE AND RCW I IT 27,
SIGNArURE, I (OWNERbR AGENT) DATE SIGNED
I " -, '0 1 A7.4 L� — I I/ j o +
-9 /14/
PERMIT EXPIRES
USF PERMIT 14
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NF
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E NUMBER-, V_ /I
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JOB SUiTE/APT#
ADDRESS
PLAT NAME/SUBDIVISION NO
OTNO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Peirnit Roquifed
Stroel Use Permit Peri'd
EXISTING — PROPOSED
Inspar.ijan Required
Sidewalk Required
REQUIRED DEDICATION— FT —
Undaigioand
Wiring inquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 13 No 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
ENGINEERING REVIEWED
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
DATE
DATE
SHORELINE OR ADI1,1 I ,11NSPECTION I BOND
REO'D I POSTED
CIYES ONO IS
SIGN AREA HEIGHT
FALLOWED . PROPOSED I ALLOWED , PROPOSED
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IC
REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.) I
FRONT SIDE REAR FRONT 1IR SIDE 7REA7RJO
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2
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LOT AREA I PLANNING REVIEWED BY DATE In
CHECKED BY
ITYPE PN
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JC'T E
OCCUPANT
GROUP X
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SPECIAL INSPECTIO�
REQUIRED [3 YES
JAREA
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
NALUATION
Description
FEE
Description
FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Ian Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
ecording Fee
R Recording F
Receipt #
X-1).
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CALLBuilding
0 S
rFORINSPECTION
I
(425)
771-0220
APPLICATION APPROVAL
This application is not a permit until signed by the
official or hisitier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DAT E
RFI`f;-'NSFD 13Y DATE
ATTENTION CA I 1%3aa It I,A
-RUCTURE UNTIL I " /) 4
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR S1 Y�&p T
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YrLLOW - INSPKCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
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0 M
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1711
11
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
Retaining Wall ...........
0
I
Slab Insulation .......... 0
M
PLUMBING:
=n
Underground .............
M
Rough -in ................... C
M
Commercial Final ...... 0
If 0
0 C
HEATING: —4
M
M
GasTest ....................
10
Gas Piping ................. > z
Equipment ................. Cn
0 -n
Commercial Final .......
EXTERIOR SHEATHING
M M
NAILING ..........................
a
0
FRAMING ........................ 0
M
C 0)
FIRST FLOOR FRAMING ...
Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
z
Ceiling Insulation .......
SHEETROCK NAILING ...
z
0
SPECIAL INSPECTION ...
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR L4
OCCUPANCY ..................