20040125.pdf0
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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cc MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME 111111-4-
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NAME
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ZIP TELEPHONE
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CITY ZIP TE PHONE
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STATE 6CEN§E NUMBER EXPIRATION DIATE
CHECKED BY
1,111je�
SRoPERTY TAX ACCOUNT PARCEL NO.
q�zla_ cc, _LW3_cod.�. qs
-ORO )c)-
NEW
RESIDENTIAL
0 PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
11 CHANGE OF USE
REMODEL
MULTIFAMILY
1:1 SIGN
REPAIR
FENCE
11 ( X Fr)
GRADING
CYDS
DEMOLISH
TANK
1:1 OTHER
GARAGE
El CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
1:1 FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
oFF1_CE
NUMBER
OF
NUMBER OF
DWELLING A111
4
CRITICAL
AREAS
1
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
Tie'AIA A/
HEAT SOURCE I GLAZING. %
PLAN CHECK NO:
LOT
VESTED DATE
Cl/ '50) � �r_) r_z ;0 1
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
U)
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
j
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 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 DUIY 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
WORKMEN'S COMPENSATION INSURANC5 AND RCW IB 27.
SI j1LIRE((OWNEli',lORfGE�N1 DATE 7GNE o
NX7�_,4 L _4
PERMITEXPIRES
USE
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AC
PERMIT
) � �,�
NUMBER,
JOB
SUITE/APT#
ADDRESS
IVJ9
/C 5ccl 10 Q
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Apptovad 'CL
RW Petaid Required BIN
EXISTING
PROPOSED
Sttoaj Use Permit Rect'd
inspection Required 13
Sidewalk Requited E3
REQUIRED DEDICATION Fr
Undergrotind
Winng required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES0 NO 0
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REMARKS
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OWNER/CONTRACTOR
RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY
FIRE REVIEWED BY
-'VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
IN (�
PARKING
REO'D I PROVIDED
REMARKS
1\414 I\ - 5
CHECKED BY 17F
SPECIAL INSPECTIO
REQUIRED-56 YES
f
DATE W
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SHORELINE OR ADS# I INSPECTION BOND
Lfy+EO'D POSTED
S
�24 ONO IS
SIGN AREA HEIGHT
ALLOWED , PROPOSED ALLOWED , PROPOSED
NA NL
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (171)
FRONT SIDE REAR FRONT URSIDE REAR
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LOT AREA PLANNING REVIEWED BY DATE 5
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TION
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
314W Itt C_
VALUATION
$ I /-P-/
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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FEE Description FEE
State Surcharge 216-29
CitySurcharge_ /Y3
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt P
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APPLICATION APPROVAL
This application is not a permit until signed by the
Building Olficial or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided
)DATE
ATTENTIOM IJ
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOWIINSPECTC
PINK -OWNER GOLD -ASSESSOR
GREEN - ACCOUNTING
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FINAL PRO CT APPROVAL FORM
TO:
DATE:
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
FIRE DEPARTMENT DATE -----------
..FROM:. RRAW
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FINAL PROJECT APPROVAL FORM
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DATE:4) IC11"04
MEMO TO: PERMIT COORDINATOR, BUILDING DIVISION
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Date Signature
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Date Signature
1:temp:b1dg:forms:ocaprv1 3/25/04
BY: EDMONDS; 4257441400; FEB-11-04 10:20AM; PAGE 2/3
�ENT BY: EDMONDS; 4257441 400; IFEB-4-04 i :SiPli; PAGE 1/2
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall...........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ............. -
Rough -In ................... . . .
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping ......... .......
Equipment ........... ......
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
1—D rl,� Floor Insulation .........
rvc Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ... w\S
SPECIAL INSPECTION ...
IN
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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