20040152.pdfRECEIVED
C1W OF EDMONPS
CONSTRUCTION PERMIT APP,LICATION
OWNER NAME/NAME OF BUSINESS
irl MAILING ADDRESS
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CITY ZIP
Edmorids 98026
NAME
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ADDRESS
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PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES
PERMIT
NUMBER
SUITE/APT#
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TELEPHONE EXISTING - PROPOSED
425-E70-1918 REQUIRED DEDICATION- FI
METER SIZE LINE SIZE NO, OF FIXTURES
CITY ZIP I T
NAME
CBL #
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Plamb Si7ns Inc
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ADDRESS
8
909 S. 28t'-1. St.
4
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CITY ZIP
TELEPHONE
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Tacoma 98409
253-z73-3323
STATE LICENSE NUMBER EXPIRATION
DATE
CIACKED�BY
PLUMBSI077QS 11/10/05
PROPERTY TAX ACCOUNT PARCEL NO.
27042900307400
NEW RESIDENTIAL
PLUMBING ir MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
REPAIR GRADING
CYDS
FENCE
x F70
DEMOLISH TANK El
OTHER
Axn i u
oGARAGE RETAINING WALL
FIRE SPRINKLER
CARPORT ROCKERY
FIRE ALARM
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(TYPE OF USE, BUSINESS 013 ACTIVITY) EXPLAIN:
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Retail Salc-s
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NUM13ER
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NUMBER OF
DWELLING
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STORIES
UNITS L/qTAN
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BER
DESCRIBE WORK TO BE DONE
Install illumir.atend aurni g ovEr
Drivc Thru Pharmacy indo-v on
South anlevation of buildina. I
HEAT SOURCE
GLAZING %
LOT SLOPE %
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PLAN CHECK N �) q I V.STED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS P _RMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONS In NONTHEPUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
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CL PERMIT LIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
"APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT I OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY THE CITYS ABIL11-Y TO ENFORCE ANY� ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I 14AVE READ THIS APPLICATIO ; THAT THE INFORMATION
GIVEN IS CORRECT, AND THAT I AM THE OWNER. OR THE DUL 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 PE ISON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 10.27.
�Sl !rURE (OWNER OR( ENT) DATE SIGNED
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'..' .1 7 10 / 0 4
� 3k,
[.to NO,
LID FEE $
TESCP Approved
13
RW Permit Required
13
Siteat Use Permit Roq'd
(3
Inspection Required
13
sidewalk Required
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underground
Wiring required
13
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
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REq'D
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SIGN AREA
HEIGHT
COMPLETE EXEMPT
I OWED PROPOSED
ALLOWED PROPOSED
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EXP
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LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
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FRONT UR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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OCCUPANT.
GROUP
SPECIAL INSPECTION
AREA
OCCUPANT
REQUIRED S
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LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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VALUATION
$ / �
Description
Plan Check
Building Permit
PILImbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp,
Recording Fee
CALL
FOR INSPECTION
(425)
-77-1 nr3*3n
LD/BY DATE
AT EN I IU / r.A I I JJJ
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND API ROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UB( SECTION 109
09,03 PRESS HARD -YOU ARE MAKING 4 COPIES
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FEE
Description
FEE
I
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Arrit. Due
Receipt #
APPLICATION APPROVAL
1 his application is not a permit until signed by the
Building 011icial or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FICIA �_GNATURE DATE
FA
ORIGINAL -FILE YELLOWZINSPECTC
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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 ..........
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FINAL APPROVAL FOR
OCCUPANCY ..................
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