20040147.pdfDATE RECEIVED PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER
JOB 01 IITFLIAPTU
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CONSTRUCTION P ERMIT APPLICATION ADDRESS- 'S k
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OWI'L!E,:,JAME/NAME OF BUSINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE $
MAILING ADDRESS I
IESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
3r k ]�rll ') L_ t") Street Use Permit Roq'd 0
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0 CITY 7> EXISTING — PROPOSED inspection Required [3
ZIP TELEPHONE Sidewalk Required L3
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 93
YES NO z
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REMARKS z
ADDRESS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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ENGINEERING REVIEWED By DATE
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FIRE REVIEWED BY DATE Lu
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t;;�rr(F_ 2_6 VARIANCE OR CU SHORELINE OR ADEII INSPECTION BOND 0
EXPIRATION DATE CHECKFD, BY REO'D POSTED M
STATE LICENSE NUMBER DYES ONO S i
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED _n
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) C
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR M
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COMPLIANCE OR
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PARKING LOT AREA PLANNING REVIEWED BY DATE -4 K
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SIGN M Z
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DEMOLISH TANK X
GARAGE RETAINING WALL FIRE SPRINKLER W
CARPORT ROCKERY E] FIRE ALARM 0 -n
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(TYPE OF USE. 13USINESS ACTIVIIEXPLAIN:
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0 OF DWELLING AREAS SPECIAL INSPECTION JAREA 0
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0 STORIES 1i I I I R �j REQUIRED [] YES 0
DESCRIBE WORK TO BE DONE 1 11 . q 0 M
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REkQ'D 5 K Cn
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Description FEE Description FEE
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PlanChpck 3(o State Surcharge 0
HEAT SOURCE GLAZING % LOT SLOPE % City Surcharge
Building Permit 1-14119- 0
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PLAN CHECK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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IL PERMIT LIMIM I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION — -----
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY 0 INDIRECTLY
2: FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF 1HIS PERMIT SHALL NOT BE LandscapeInsp. Total Amt. Due
MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
DEEMED TO
0 NOR LIMIT IN ANY WAY THE CITY,S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.* -7r
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 DU& AUTHORIZED AGENT OF
LATING CONSTRUC- I his application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGU CALL Building 011icial or his/her Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S C�yf?F_NSATION INSURANCE AND RCW 111.27. ICIA S SIGN E
AT
_-I NATUI (OWN OR AGE DATE SIGNED (425)
fo" "-2-2cl/ - ci-�, 771-0220�_, [,EASED ... BY- DATE
ATTENTION DIU 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL ___j
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
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
ITI
Slab Insulation ..........
PLUMBING:
Underground ............. M
C
M 0
0
Rough -In ................... C)
0
C
Commercial Final ......
x M
ITI
z
HEATING:
C z
Gas Test .................... >
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Gas Piping .................
4
o -n
Equipment .................
Commercial Final .......
MITI
0—
EXTERIOR SHEATHING Cn
NAILING ..........................
0 rn
C: CD
FRAMING ........................ M Cn
M 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
3:
Floor Insulation ......... >
z
Wall Insulation ...........
x
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Ceiling Insulation ....... z
0
SHEETROCK NAILING ... --I
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
700to 0147/