20040159.pdfI
DATE RECEIVE�,,,
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
10�W�31ER ME/NAME OF BUSINESS
be aq
MAILING ADDRESS
ILIT\ &4F
CITY ZIP 7FLEPHONE
:'_�? N
z
NAME
W
1= ADDRESS
x
L)
CITY ZIP
TELEPHONE
NAME
UJ_A__Sk1 '1ibV'X �J��.rCliLj
S�,rV
CBL #
It (x
ADDRESS
CITY
LEPHONE
-Z� yw')n
STATE LICENSE NUMBER
E� Sq_7 I CO
EXPIRATION DATE
CNOS IWO
14
PROPERTY TAX ACCOUNT PARCEL NO.
NEW
WRESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYOS
F� DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS
OR ACTIV" EXPLAIN:
L)
V,
w
a
NUMBER
M
OF
0
STORIES
DESCRIBE WORK TO BE DONE
ri
Lcif-c-c-teJ bijinc,
'Zol
1-2
GLAZING %
ECK NO:
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
USE
ZONE
inn
PERMIT EXPIRES 3
PERMIT
NUMBER
ADDRESS -tit Iq
AME/SUBDIVISION NO. LOT NO
!� I I �
" 0114:
SUITE/APT#
IV
LID NO,
LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP M Poirria Required
EXIS eftel"fMIJ rQ so Parma Flori'd
ITACL� � � 4nisp'eLin Requirad
ffl,ftT" ?O,jnd
'. E�ll�tj:4C; Wiring lquired
U19E JIZE,,'.>,� t N &S + REQUIRED
f2l f e 1- - 11.1"�?_ . AMWO NO 0
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENG
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEI
EXP
I OT COVE
ALLOWED PROP(
PARKING
REO'D I FROVIDED
REMARKS
3Y DATE
spaces. UMC 815.1.7
DATE
SHORELINE Oil ADI1,1 I INSPECTION I BOND
REO'D POSTED
[1YES ONO IS
cr
W
z
z
E5
z
W
UJI
SIGN AREA HEIGHT
ITH-Tiq I ISILCULT) PROPOSED
rwiv m 0DK:1%TnL
f1kIJ*5I!TB)&% JFT!tI" YAO"OdItlFBACKS (FT.)
wMIS" UR SIDE REAR
11-11-0 SRAL Fffff z
E
z
LOT AREe ='D BY DATE 5
i IL
CHECKED BY JTY)XF rOnT,.UjT�1ON CqE-1 OCCUPAN,�?
CRITICAL e� _T GROUP
AREAS SPECIAL INSPECTION JAREA OCCUPANT
NUMBER REQUIRED [:] YES LOAD
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D 25
o V Y1 44 o,- if ��)
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMM. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 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
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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 CONSTRUC-
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VI'6LATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INNRANCE AND RCW 18 27.
X(G,ENT)
RE (OWN("'qn DATE SIG14ED
d
74./ 1 �iK V
VALUATION
$ r-7 d
'_� V_
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
I
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid. and
receipt is acknowledged in space Provided.
-FICIA�S SIGNATURE DATE
:LEASED BY T DAT�B�,
A17ENTION 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
z
0
4
0
M
--i -n
M
C
M
0
C)
0 C
-4 C
X M
M Z
01
C:
0 -n
n
—4
x
M M
055
0 r-
0 M
C U)
F, (1)
M 0
Z
7'
z
U)
z
0
M
.1
''RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing...................... --------
............
-Pi6ilPorch .................
Reiainihg Wal ...........
Slab Insulation ..........
PLUMBING:
Und&rdr��nd�� .................
Rough -In .......... ........
Commercial Final ......
HEATING:
GasTest ....................
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 ..................
z
0
A
0
M
4 -n
M
C
M
0
0 C:
3: rn
ITIZ
C _Z
3:
C/)
0 _n
_n ;U
_.j >
x im I
M M
0
0
0 M
C cl)
90)
M 0
Z
;0
—i
z
-4
M
z
0
I
0
M