20040161.pdfDATE RECEIVED %I � I N
zl� a PERMIT EXPIRES
UtE PERMIT
CITY OF EDMONDS ZONE NUMBER �_7_ - ',�)
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS,") -7 L-1
IT NAME/NAME Or 13USINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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CITY ZIP TELEPHONE
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NAME
ADDRESS
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CITY ZIP ITELEPHONE
NAME CBL Al
ADDRESS
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIR TiON DATE C14EC-KED BY
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E 3 e7 7
PROPERTY TAX ACCOUNT PARCEL NO
LID FEE $
TESCP ApProv0d 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rvv Permit Required 13
Street use Permit Roq'd 13
inspection Required 13
EXISTING — PROPOSED de.waik Required C3
REO�IRP .I wiring raqqed [3
P!_�D ICAT ION FT
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""'PAV49EQUIRED
YES d NO 13
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
tDATE
;om
PDATE
VARIANCE OR Cu SHORELINE OR ADBO INSPECTION BOND
RE:(Q D POSTED
OYES L8 N Ois
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
EXP t
NEW
RESIDENTIAL N'
PLUMBING / MECH
COMMERCIAL 13
COMPLIANCE OR
ADDITION
CHANGE OF USE
El REMODEL
MULTIFAMILY 11
SIGN
El REPAIR
GRADING
CYDS 11
FENCE
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DEMOLISH
TANK 11
OTHER
GARAGE
RETAINING WALL
11
FIRE SPRINKLER
FIRE ALARM
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CARPORT
ROCKERY
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(TYPE OF USE,.BUSINESS
OR ACTIVITY) EXPLAIN:
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NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
to
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STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
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PLAWCHECK NO: 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.
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PERMIT APPLICATION: 180DAYS
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CL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
( U) 'APPLICANI, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
'I
cn ITY OF
IS
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE C
2 EDMONDS. WASHINGTON. ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
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c ALL CLAIMS FOR DAMAGES OF WHATEVER NA1 LIFE, ARISING DIRECTLY OR INDIREC'I LY
At.j. NOT BE
:C1 FROM THE ISSUANCE OF IHIS PERMIT. ISSUANCE OF IHIS PERMIT SH
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0 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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0 NOR LIMIT IN ANY WAY I HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
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CHECKED BY
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ECDC '19.30.020 (c)
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.TBACKS (IFT.)
SIDE REAR
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ATE
OCCUPANT
GROUP
SPECIAL INSPECTIO� !AREA OCCUPANI
REQUIRED [:] YESa�
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D F5
3
VALUATION
$ I ,
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp-
FRecording Fee
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-
iiON. AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COM PE NS�TiON.INSU RANCE AND RCW 18.27. � I
DATE SIGNED
FEE Description
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
'77A, /r 7/"1, ?L--klf iii' I I I I I —Uzzu RELEASED BY DATE
'AfitNTION E)ff 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
FEE
Plan Chk. Deposit
RecEeipt
Total Amt. Due
Receipt # 1 4/�2
APPLICATION APPROVAL
This application is not a permit until signed by the
Building oilicial or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided,
OFFICIA)_S SIGNATURE I DATE
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ORIGINAL - FILE: YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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171
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS . .....................
FOUN6ATION,
Footing ......................
Wall.......................
Pier/Porch ................. z
0
Retaining Wall ............. -4
0
'�Iab Insulation ...........
PLUMBING: =n-
Underground ..............
0 M
C
................. M
Roogh-36 ...... 0
tia 0 C
I Finai ......
--I
HEATIN G M
M z
IC) --I
Gas Test ....................
Gas Piping .................
CO)
-n
Equipment ................. 0
Commercial Final .......
=
m m
EXTERIOR SHEATHING
NAILING.......................... 0
0 ITI
C 0)
? FRAMING ........................ K Cn
Q 0
FIRST FLOOR FRAMING ... Z r-
-I
INSULATION ................... ;U
--I
Floor Insulation ......... M
>
z
Wall Insulation ........... —11
Ceiling Insulation ....... Cn
z
SHEETROCK NAILING ... 0
i
SPECIAL INSPECTION ... 0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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