20040149.pdfDATE RECEIVED
LPERMIT EXPIRES
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USE PERMIT
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CITY OF EDMONDS NUMBER,
JOB
CONSTRUCTION PERMIT APPLICATION SUITE/APT#
ADDRESS
OWNER NAMkINAM
E OF BUSINESS
—ay( I PLAT NKME/SUBDIVISION NO, LOT NO LID NO.
MAILING ADDRE.SS
W LID FEE $
TLSCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 RW Permit Required 0
1 Q 4f A A XA-164 Street Uso Parma Roq'd 13
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required 13
Sidewalk Haqivred E3
REQUIHFD DEDICATION— FT Underground
42-2, f71'L 16 2v 1,3�— 7 Wiring required
METER SIZE SIZE NO, OF FIXTURES PRV REQUIRED
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YES 1:1 NO 13
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L- ADDRESS REMARKS z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE Z5
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CITY ZIP LEPHONE GAS NPE *FESf MUST BE
r. USFAVED BY GITY !NSPECTOR
NAME BL 4 0
ENGINEERING REVIEWED'67 w & 1 %A SHALL NOT —DATE
ct ADDRESS
0 ACCEPTED
FIRE REVIEWED BY DATE LU
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VARIANCE OR Cu SHORELINEORADBAt I INSPECTION BOND
S 1! 66 1 tNSE NUMBER EXPIRATION DATE CIIEC ; �ED REO D POSTED
I 1 11 / "I f OYES ONO S
'01, 1
_j y SEPA REVIEW SIGN AREA HEIGHT
< PROPERT� TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
0 1
LU EXP
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REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
E 2/RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
NEW CLUM61NG/ ECH LOT COVERAGE
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ADDITION COMMERCIAL 2
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I Pf"ll,
GRADING FENCE I Re_�4dless of �hether the water systern
1:1 REPAIR E] CYDS ( — X FT) REMARKS is open or closed, expansion tanks are
F-1 DEMOLISH TANK E3 OTHER requhd on all hot water tanks per
Ei GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 1:1 FIRE ALARM ECDC 19.30.020(c)
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: ----
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CHECKED BY ITYPP/ONSTRUCTI N OCCUPA
GROUP
Lu 127 7�1
NUMBER NUMBER OF CRITICAL
M OF DWELLING AREAS SPECIAL INSPECT& AREA OCCUPANT
0 STCRIES U NITS NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE V
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D Ei
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
6 Q-�k I Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: 180 DAYS
IL PERMIT LIMIT., 1 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
ul IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS THE CITY OF
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.2 EDMONDS, WASHINGTON, ITS OFFICIAL S. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRrcrLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 1
NOR LIMIT IN ANY WAY THE CITY'S ABILITY 10 ENFORCE ANY ORDINANCE PROVISION. -
Recording Fe Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I - 6�/
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THEOWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULA1 ING CONSTRUC I his 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
F I IAI S SIGNA URE DATE
SIGNATURE (OW�ER'bii AGENT) DATE SIGNED (425)
771-0220 TIE
ASED' BY'
DATE
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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
091,03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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 ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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