20040138.pdfDATE RECEIVED
LPERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB I E/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 4
OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
I LID FEE S
MAKING ADDRESS JESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW PI'Mill floquirod 13
87/02.�� ireei use Permit 1100 13
0 /< Inspection Required
EXISIING� PROPOSED� sidewalk laorpirad (3
CITY ZIP TELEPHONE uridelq(Mind
gge 721:� REQUIRED DEDICAIION_ FT Warno ioquired 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED ED
NAME Z
YES13 NO 11
L) Z
W Z
t ADDRESS REMARKS ROL/DRAINAGE
OWNEWCONTRACIOR RESPONSIBLE FOR EROSION CONT
1HTE'U W
a:
< GAS 6 lis ST BE'
CITY PHONE vrvq
013SUiVED BY CITY INSPECTOR
NAME ICBLft ARIDAVIIS SHALL NOT
*1 —A T
ATE
ENG NEERING REVIEWED B; D
Ccj AD
0
DAJE W
'By or L ve"t
FIRI ""D appliall
CITY TELEPHONE -burning (NS Ito
0 zip required oil fuel
64,erec�� ec;�WP %)5-- 777�1 P0MNEb#ybbff OeZotN S.._JBOND
i7E OSTED
ES
SEPA REVIEW SIGN AREA HEIGHT
EVE OPOSED ALLOWED , PROPOSED
1;
EXPIRATIO TE PkiECK BY
STATE LICENSE NUMBER 40
try
............ COMPLETE EXEMPT ALLOWED PR
< PROPERTY TAX ACCOUNT PARC L;.40
W EXP
LOT COVERAGE _"(fZH_ -l"IMUSEIrf ETBACKS (FT.)
NEW ESIDENTIAL PLUMBING I MECH ALLOjffff`"ff6P ED FRONT SIDE REAR kIONT R SIDE REAR
H jr= .4 Z
W ectrical Per 2
ADDITION COMMERCIAL COMPLIANCE OR Obt Z
El El CHANGE OF USE P BY ATE 5
AR
REMODEL MULTIFAMILY SIGN
GRADING o FENCE REMARKS
REPAIR CYDS I X FT)
E DEMOLISH TANK 0 OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
Z CARPORT ROCKERY FIRE ALARM
(TYPE OF.� BUSINESS OR A�71VITY) EXPLA�� TYPE OF CO R CEO
CHECKED BY
L)
9
F AL
W NUMBE4f!!!�5 ��UMBER 0 CRITIC SPECIAL INSPECTION AREA
M I DWELLING AREAS REQUIRED [3 LOAD
a OF A� UNITS NUMBER YES
0 STORIES 67 — I
DESCRIBE WORK TO BE DONE
V,erz REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
*117P 1=1�Fe 1��Ie_ ee
_.X
ck;
)Zoe-,177 ION
_40
et/�P; Al $
rA!Fx_15, Description FEE Description FEE
7— Plan Check State Surcharge
ING % LOT SLOPE % Building Permit City Surch rge
VESTED DATE Plumbing Base Fee
PLAN CHECK NO:
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:j SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 1130 DAYS
W Engr. Inspection
UL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION r____
LICCESORS Fire Review Plan Chk. Deposit
in 'APPI ICANI. ON BEHAt F OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND S
tn -HE CITY OF
UJI IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS I
_j AND AGENTS FROM ANY AND Fire Inspection Receipt #
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES,
S FOR DAMAGES OF WHATEVER NAlURE, ARISING DIRECTLY OR INDIRECTIN
ALT CLAIM
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT [IF
nrr:mFn 10 MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE- Landscapelnsp. Total Amt. Due
ABIHIY TO ENFORCE ANY ORDINANCE PROVISION' Recording Fee Receipt III
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, Oil THE DUTY AUTHORIZED AGENT OF I his application is not a porma until signed by tire
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULA1 ING CONSITILIC CALL Building Official or liis/her Deputy. and Fees are paid, and
TION. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATIgjj.-QF_THE LABORCODE OF THE STATE OF WASHINGTON RELATING 10 FOR INSPECTIO receipt is acknowledged m space provided
WOR IVS COMPENSA)ION 1913URANCE AND RCW 18 27. 0 1 , AIS SIGNATL F DAN
(OWNE n EN DAI E SIG��ED (4255)
771-0220 1 FASFD BY
TENTION R OCCUPY A BUILDING OR STRUCTURE UNTIL E)ff 1333
IT Is UNLAWFUL TO USE 0 BEEN MADE AND APPROVAL Oil A CERTIFI- ORIGINAL - FILE YELLaV INSPECTOR
A FINAL INSPECTION HAS ED. UBC SECTION 109 PlNK-0*NER GOLD -ASSESSOR
CATE OF OCCUPANCY HAS BEEN GRANT
oq;03 PRESS HARD -YOU ARE MAKING 4 COPIES
Z
0
1
0
M
-1 -n
M
M
0
0
0 C:
M
M Z
r') -1
C
x
W
o -n
ri
M M
0 5)
0 r-
0 1711
C: 0)
9 Cn
ITI 0
Z 17-
Z
Cn
Z
0
M
U
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
.::�FdUkb�TIbN;:..
Footing .......................
Pier/Porch .................
FkAlhlng Wall .......... .
§Iab Insulation ...........
PLUMBING:
............. .
Rough -In ...................
Commercial..Final
HEATING:
Gag Test .......... .
Gas Piping .................
Equipment ............
Commercial Final .......
EXTERIOR SHEATHING
NAILING ............... 6 ..........
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation ......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
12� %.
01
fNI- 144
z
0
1
0
M
-4 -n
M
M
0
0 C
M
M Z
C
0 -n
n
-4
af
M M
0
0
171
C c) I
F. Cn
M 0
Z
3:
z
Cn
z
0
1
0
ITI