20040160.pdfI
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PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER Zad 01
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
S�eelv&,e6 ky+44q_*, PLAT NAME/SUBDIVISION NO. OT NO. LID NO.
m 7 LID FEE $
LU MAILING'ADDRESS —
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP SW Permit Required 13
0 Street Use Permit Rect'd [3
I i -7 EXISTING — PROPOSED inspection Heclurred [3
CITY ZIP TELEPHONE 'ffnwalkRocittired [3
R�%R�D QEDIQ� N Uniferground E3
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NAME METER SIZE LINE S�E NO. QF FIXTURES PRV REQUIRED
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OWNERICONTRACTOR RESPONSIBLE FOR EROSION CON
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STATE LICENSE NUMBER EXPIRATION DATE CHACK41) BY REQ*D POSTED
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ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
PROPERTY TAX
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ENEW RESIDENTIAL PLUMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 0
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COMPLIANCE OR 2
ADDITION COMMERCIAL CHANGE OF USE 2
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR El CYDS I X . Fr) REMARKS
OTHER
DEMOLISH TANK
Ei GARAGE RETAINING WALL FIRE SPRINKLER
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'�: (TYPE OF USE. BUSINESS OR ACTIVITY) EXP
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/I OCCUPANT
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at NUMBER NUMBER OF CRITICAL OCCUPANT
a OF DWELLING AREAS SPECIAL INSPECTION JAREA
1:0 1 1 �5� LOAD
0 STORIESI -A'ist NITS NUMBER Y3 REQUIRED [3 YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 1108,11FINAL INSPECTION REQ'D — 9
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Description FEE Description FEE
6 46,:v —
let_ State Surcharge
t-_3 L f, Plan Checlk
HEAT SQURQS GLAZING % LOT SLOPE Building Permit City Surcharge
PLAN dHECK VESTED DATE Plumbing Base Fee
Mechanical .2
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO e
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
all
04 PERMIT LIMIT, I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
LU IN INTERESf. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N
ALI- CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT Y
FROM THE ISSUANCE OF IHIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
93 DEEMED To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY -THE CI1YS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.4
Recording Fee Receipt 9 e
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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 DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial 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. OF Sf GN TURE ATE
DATE S NED (425)
S7IGNKATRE (O:WNE ), 0__ A 7E:,/T),
771-0220 RELEASE6 B� DATE
EXT 1333
E14TION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OFAIG114AL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing . .............. .......
Wall ..........................
Pier/Porch ............
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Retaining Wall ............ . -4
0
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Slab Insulation ......
PLUMBING:
'Underground .............
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IR66gh-ln ................... rn
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0
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Commercial Final
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......HEATING: IT! z
Gas Test .................... C z
Gas Piping .................
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Equipment ................. 0
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Commercial Final .......
M M
EXTERIOR SHEATHING 0
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NAILING .......................... 0 r-
0 M
FRAMING ........................
M 0
FIRST FLOOR FRAMING... Z
INSULATION ................... ;U
Floor Insulation ......... >
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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