20040118.pdf - LEGACYI
L)
W
I "1:111III111:10
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINE
(_ 14 0, 1 CL, Ze)'r)
MAILING ADDRESS
-7 1 Ll
CITY
Ff)
NAME
I
L Olf I I PERMIT EXPIRES
P L c->
ZIP [TELEPHONE
rl'b o 2x_.: r 4 Z_ S) -7 7 3 2-4,, 7 Z_
ZIP ITELEPHONE
NAME I CBL is
cz.- FL4wi F,
ADDRESS
1 _�;7 2-1 1_111c'.0 C—i-r-y jA� t.:3 E_
CITY ZIP TEL EPHONE
81 -z z 's -S 1�'
STATE LICENSE NUMBER EXPIRATION DATEI CHECK
RL %J E_ F L * 9`1 -7 P
PROPERTY TAX ACCOUNT PARCEL NO.
_), - 7 2- _'* -_ N— C) C-) I
I -�
y
H C.� C30
1-1
NEW
J<RESIDENTIAL
F LUMBING I MECH
X
El
ADDITION
1:1 COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
El rynp.
M
FENCE
( X. FT)
DEMOLISH
TANK
r_1
OTHER
EGARAGE
RETAINING WALL
El
FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE. BUSINESS
EXPLAINA
NUMBER NUM8ER OF
1 1 CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
1a1v1ira_ -i tu* —,oaz dert -rp,>Z c>1/r
1�u7'
C A
4C 2— /0 1 1; ru��_
9 "51C
10
HEAT S GLAZING %
,QURCE LOT SLOPE
6-71S flao0le-1- I I
PLAN CHECK NO: I 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.
cc PERMIT APPLICATION: 180 DAYS
W
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Lit IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS rHE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENI'S FROM ANY AND
cc
4 ALL CLAIMS FOR DAMAGES OF WHAI EVER NATURE, ARISING DIRECTLYOR INDIRECrI.Y
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT 13E
0
_j DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 Noll LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THA-r I HAVE READ THIS 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 TV15 WORK AUTHORIZED rilEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF TLIP-LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMFIE)(SAtION INSURANCE AND RCV� 18 27.
SIGNATU�E�' f! R. �AGEN$Tj DATE SIGNED
-�/ /-6
USE. PERMIT
ZONE NUMBER
G I I
JOB SUITE/APT#
ADDRE
SS _71+
PLAT NAME/SUBDIVISION NO LOT NO, LID NO.
I LID FEE S
PUBLIC RIGH ?E�,QFFPtAI4UPPT IESCP Approved E3
MIA AW Permit Required 13
Sir or use Permit Rrrq�d 13
EXISTIN BE Inspection Required 13
V2 14 TY I j '.!
I-- �' 1, Uft
RR fli�IEVD -
Rip :qwalk Required [3
1 rground
j j u
REQUIR
)FXT r g required E3
METER SIZE r"llwuld I #)I
ME PRV REQUIRED
B E A C *I'E P10 F_ 0 YES IJ NO 1:1
REMARKS
Type -b" or 1, vent cosimoctors
required on fuel -bz� -ri -,-hig applianess In
unhaafed spaces. VIVIC. 315-1.7
W
z
z
a
z
W
-�- '�' I ISU
FIRI R(JFJ��'y 'q froWTE'
9r livniiiiiefrienf.:
VAIIAhdtll�(n "slHoRELINE OR ADB# I INSPECTIO�.I_ BOND
�1 ,.~ . �' �. POSTED
IDYES ONO IS
SEPA REVIEW SIGN AREA I HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSEa_J..&66QWLH" PROPOSED
EXP �jhe wated system
111
REMARKS
CHECKED BY I TYPE
XIWX
%Fr- 0 0 ETB CKS (FT)
I (Ftj
R FRONT SIDE REAR
but tivater tanks er z
z
z
CA jj9j3=M(qWEO BY ATE 5
1 CL
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTI(
(425)
771-0220
11
FEE Description
State Surcharge
City Surcharge
Ll /,-) I Base Fee
FEE
Plan Chk. Deposit
Receipt it
Total Amt. Due
1 Receipt # 127 C__ C�v
t� j,4 0
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy* and Fees are paid. and
receipt is acknowledged in space provided
=FIC SIGNAT IE �ATEe
-1 EASED BY D&E
ATTPENTION I E)ff 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
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
D
M
z
0
i
0
1711
--I -n
M
M 0
0
C)
0 C:
M
M Z
—z
CD
o -n
n
M M
0 —C/)
0 r-
0 M
C Cf)
90)
M 0
Z
r
z
Cf)
z
0
1711
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ........
z
Piei/Porch .................
Reia'ini6dWall 0
M
Slab Insulatiori* ............
-PLUMBING:
M
---Undergropmd ....... ......... C
0
M 0
--40
R�ugh,-)rf
0 C:
M
mz�
HEATING:
z
Gas Test ..... .............. -4
x
Gas Piping ................. 65
Equipment .................
Commercial Final ITI IT!
0 r—
EXTERIOR SHEATHING 0 M
NAILING .......................... C= (/)
90)
FRAMING ........................ M 0
Z r—
FIRST FLOOR FRAMING ...
INSULATION ...................
r
Floor Insulation ......... z
Wall Insulation ...........
Ceiling Insulation ....... z
0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR 621
OCCUPANCY ..................
0HF11