20040131.pdfi
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DATE RECEIVED [PERMIT EXPIRES
USE PERMIT
ZONE
CITY OF EDMONDS NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NIAME OF BUSINESS M
4W9W, - A� ?) 0,, L 1, " PLAT NAME/SUBDIVISION NO. 7LOT NO. LID NO.
2C MAILING ADDRESS LID FEE $
u TESCP Approved 0
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
il: 13 13
0 Izo W . LV Street Use Permit Roq'd [3
CITY zl� TEIkPHONE EXISTING — PROPOSED inspection Requited 0
Sidewalk Required [3
ti�o. le q REQUIRED DEDICATION— FT Underground
Wiring required 0
NAME Pq METER SIZE LINE NO. OF FIXTURES PRV REQUIRED
YES NO
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t: ADDRESS REMARKS z
3: OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE 0
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ZIP _JTELEPHONE
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NAME CBL#
n" r6elt� ENGINEERING REVIEWED BY DATE
a: A*6DRESd I
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1 —7 FIRE REVIEWED BY DATE W
C TY TELEPHONE iz
ZIP
MLT q (..0 VARIANCE OR CU SHORELINE OR ADEII INSPECTION BOND
STATE qENSE NUMBER ExPIRAT ON JATE CIj2CI?;D_0y\ REO'D POSTED
er� Ao Z F I — EIYES ONO S
I Ot- Pfil " SEPA REVIEW SIGN AREA HEIGHT
PROPE&Y TAX ACCOUNT PARC�NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
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PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
z
COMPLIANCE 08 -2
ADDITION 'f7,j,-tOMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REQ'D PROVIDED
REPAIR GRADING FENCE
CYOS ( X FT) REMARKS
DEMOLISH TANK o OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
FYPE OF USE. BUS ESS 0 V y/Ty) P iA IN; CHECKED BY IT] TION 6 OCCUPANT
1!271 GROUP
U)
U3 NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
M UNITS NUMBER REQUIRED LOAD
0 STORIES YES
DESCRIBE WORK TO BE DONE
REMARKS z
H11 PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 9
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee T
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
U)
ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
Ir
4 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
0 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE FROVISION.*
X1 Recording Fee Receipt N
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 COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC_ This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION I __ I
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. _RFFICIALEr1SjGNXTU�L;r DATE
SIGNATURE (OWNER ORAGENT) DATE S)GNED r
(425)
A 0, 771-0220 RELE dATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL L
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPEAOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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.... .... ..
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall.......................... z
0
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
M
C
Underground ............. M
0
0 C
Rough -In ...................
-4
X M
Commercial Final ...... M Z
HEATING: C
Gas Test ....................
CD
Gas Piping ................. 0 -n
Equipment .................
3:9
m m
Commercial Final ....... 0
0
0 M
EXTERIOR SHEATHING
C CD
NAILING ..........................
90)
M C.)
FRAMING ........................ Z r-
FIRST FLOOR FRAMING ... ;U
_q
3:
INSULATION ...................
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z
Floor Insulation .........
Wall Insulation ........... 0)
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Ceiling Insulation ....... 0
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0
SHEETROCK NAILING ... IT!
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................