20040184.pdfa
P
cc
4
iDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE7 NAME/NAME OF BUSINESS
MAILING ADDRESS
/10;
CITY ZIP TEi EPHONE
NAME
CITY
NAME
t(j .14d h A
ADDRESS
T c
STATE LICENSE NUMBER
it,
WASH t (--'
PROPERTY TAX ACCOUNT
F-1 NEW
ADDITION
REMODEL
1:1
REPAIR
El
DEMOLISH
GARAGE
CARPORT
GWES OF USE I
ZIP ITELEPHONE
USE
ZONE
JOB
ADDRESS
10
PLAT NAME/SUBDIVISION NO
PE-RMIT EXPIRES
PERMIT
NUMBER 2 -(A
SU11E/APT
elc_j / r- C-/
LID NO.
LID FEE $
I ESGP Approved
nw Permit Requited
Street (150 permit Hoq'd
Inspection Requited
Sidewalk Required
Underoround
Wifing required
PRV REQUIRED
YES 0 NO 13
LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE I LINE SIZE I NO OF FIXTURES
REMARKS
OWNER/CON1RAC1OR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL#j (� WLJ%jbg IV -- — -
I iv AmnAVIVS SHALL NOT
ENGINEERING R"VfEf5W " - - - -- DATE
Lj BE ACCE ED DATE
FIRE REVIEWED BY
ZIP TELEPHONE I
EXPIRATION DATE CHECKED
'ARCEL NO.
RESIDENTIAL
PLUMBING / MECH
COMMERCIAL
COMPLIANCE OR
USE
CHANGE OF
MULTIFAMILY
El
SIGN
r-1 FENCE
GRADING
IORELIV
or 3k
BOND
POSTED
0
Z
cc
ui
z
z
6
z
W
W
I
I
JUYES UNO
is I
�A NEW——
s 'T-T—
SIGN AREA
--FfEfGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
,
I
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LIR SIDE REAR
z
2
-A
z
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
REO'D I PROVIDED I
I
IL
Li CYDS ( _ X _FT) I REMARKS
TANK
F�
OTHER
RETAINING WALL
R
FIRE SPRINKLER
ROCKERY
FIRE ALARM
tL CHECKED BY I TYPE OCCUPANT[
ni I I\ . 0 111 A 0 i 9 2 GROUP
In -R
LU NUYBE NUMBER OF CREITICAL OCCUPANT
OF DWELLING AR AS SPECIAL INSPECTION JAREA
NUMBER REQUIRED LOAD
0 STORIES UNITS YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION RECI'D
M
C
S
R
H
P
E
E
E
a
M
C
C
U
KE
LA
IR
D
L
E
S
I
D
N
By
S
0
PE
Y
T
T
tREARK
PROGRESS IN
j
VALUATION
$
Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge -75-
e�Fk Building Permit City Surcharge
PLAN"CHEc'k NO: VESTED DATE Plumbing Base Fee
—0
Mechanical 0
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE Grading
:3 SEPARATE PERMISSION.
Engr. Review
ui PERMIT APPLICATION: 180DAYS
IL 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
U)
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
-.1
EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF I HIS PERMIT SHALL NOT BE
Landscapelnsp. Due
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT, ANDTHAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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 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.
OFFI IALSPIGNATUREA r/A7T E
SIGN E (OWNER R A
EN1')
DATE SIGNED
(42%z 5
771 -0220(
A,
XTANTION
EXT 1333
IT IS UNLAWFUL TO USE Oz 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
D BY
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD . ASSESSOR
z
0
1
0
M
4 -n
M
C
M
0
C-)
0 C:
M
M z
JO --i
C: —z
X
0 71
n
—i
X
M M
0 —Cn
0 r-
0 M
Cn
M 0
Z
z
--i
X
(1)
z
0
i
0
M
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:-,
Footing ...............
Wall
J 1.
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 ..................
0?00 ot giL
z
0
0
IT!
=5
M
C
M
0
—40
0 C
X M
M Z
0 -n
n _U
__j
x
M M
0 5
0 r-
0 171
C (1)
M Cn
M 0
Z
>
z
--I
z
0
i
0
M