20040108.pdf.1
V
Cr
DATE RECEIVED _C5 - I
USE
CITY OF EDMONDS ZONE
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
�54 14)6
MAILING,7RES8
cl ZIP 1EI.EPV ONE
NAME
CITY
NAME
AD
CITY
STATE LICENSE NUMBER
F-1
NEW
ADDITION
REMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF USE, I
ZIP ITELEPHONE
ZIP I TELEPHONE
EXPIRA:nON DATE
I
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
GRADING CYDS
TANK
RETAINING WALL
ROCKERY
OR ACTIIVITY) EXPLAIN:
CEIL At
PERMIT EXPIRES
PERMIT 'J(t�
NUMBER ) LI,
JOB
ADDRESS
1 1--7 L-" Sri"
PLAT NAME/SUBDIVISION NO. I LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
�FQUIRED DEDICATION— FT
METER SIZE I LINE SIZE r NO. OF FIXTURES
02_0_�'
SUITE/APT#
LID NO,
LID FEE $
ILSCP ApP?ov0d ILI
Hw Primer Required 0
Street Use Permit Roq'd 0
Inspection Paquired E3
Sidewalk Required
Undeiground
wiling required 0
PRV REQUIRED
YES 11 NO 1:1
REMARKS
OWNER/CON1RACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING R
FIRE REVIEWED BY
BY
DATE
DATE
VARIANCE OR CU HORELINE OR ADB# I INSPECTION I BOND
CHECKED BY REQ'D POSTED
I EIYES ONO IS
E]
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X Fr�
OTHER
EFIRE
]
SPRINKLER
FIRE ALARM
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
PARKING
REQ'D I PROVIDED
REMARKS
LOT AREA I PLANNING REVIEWED BY DATE
0
Z
cc
W
z
z
5
z
W
W
M
11:
0
z
-2
z
a
a (u., 13 0
CHECKED BY ITYPE =ON
I Ca) OCCUPANTP
GROUP
in
w
NUMBE
NUMBER OF
CRITICAL
C11
M
OF
DWELLING
AREAS
SPECIAL INSPECTION
]REMARKS
OCCUPANT
Ito
STORIE
UNITS
NUMBER
JAREA
REQUIRED [] Y
LOAD
DESCRIBE WORK TO BE DONE
z
PKULUiKE=S5I SPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
F3
In)
4�?Ae
VALUATION
Description
Plan Check
FEE
Description
FEE
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTED DATE
Plumbing
Base Fee
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: 180 DAYS
Id
CL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN i8o DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT. ON BEHALF OF kits OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
in
Fire Review
Plan Chk. Deposit
Lu IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON. I VS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ir
,X ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
X1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
- .
Recording Fee
Receipt #
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
THE OWNER. I AGREE TO COMPIY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
CALL
This application is flat a perimit until signed by the
11014, AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
FOR INSPECTION
receipt is acknowledged in space provided.
WORKMEN'S ��ION INSURANCE AND RCW 18 27.
OF Cl IGNATULF A.,
si �_
SIGNATIJR LOW --'—A AGENT) DATE SIGN
(425)
fPATE
771-0220
WE
f. SED BY
ATtENT'ION
EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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
09203 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
1
0
IT!
q =6
0 M
C
M 0
0
0
0 C
-4 K
:r M
M Z
%D -j
C —Z
x
Cn
0 -n
n ;d
__j >
M 9
M M
0 _W
0 17,
0 M
C: W
9 Cn
M 0
Z
7-1
;U
z
z
0
i
0
1711
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
0
--I
Retaining Wall ...........
0
M
Slab Insulation ..........
PLUMBING: --I -n
Cn
Underground ............. M
C=
Rough -In ................... M
0
0
Commercial Final ...... 0 C:
M
HEATING: M z
Gas Test ....................
Gas Piping .................
Cl)
Equipment ................. 0 -n
-n
Commercial Final .......
m m
EXTERIOR SHEATHING Cn
NAILING .......................... 0 r-
0 1711
C Cl)
FRAMING ........................ (n
M 0
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
z
Wall Insulation ........... --I
:E
Ceiling Insulation ....... U)
z
SHEETROCK NAILING ... 0
I
SPECIAL INSPECTION M
MISCELLANEOUS ..........
FINAL APPROVAL FOR 7 - 49 -It
OCCUPANCY ..................
D/
4?00