20040229.pdfI
DATE RECEIVED
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PERMIT EXPIRES
USE PERMIT
/ONE NUMBER
CITY OF EDMONDS UITEJAPT#
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CONSTRUCTION PERMIT APPLICATION ADDRESS
At
OWNER NAME/NAME PF Bl. SINESS
I , PLAT NAME/SUBDIVISION NO, 0 LID NO,
Lio FEE $
I LSCP Approved
MAILING ADDRESS od E3
PUBLIC RIGHT E IVY tl 1w P rm't "a' ":; Roq'd 13
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EXISTING Mrkjnjk�MVLMO ffft;�, Required 0
CITY ZIP TEI, EPHONE UDWI round E3
C REQUIRED DEDI wiling required
_12 314yy PRV REQUIRED
P4010 ME ER SIZE I
NAME YES [3 NO E3 FE
BE A CEPTED
U REMARKS
W SION CON TROI /DRAINAGE
t ADDRESS OWNER/GON1RACTOR RESPONSIBLE FOR ERO!
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CITY ZIP TELEPHONE
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NAME
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ADDRESS
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CITY
ZIP
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TELEPHONE
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STATE LICENSE NUMBER
EXPIRATION DATE
CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
: 11.7
�3/
(23/
2rL
NEW
RE916ENTIAL
E34"LUMBING I MECH
El ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS ( � X
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL FIRE SPRINKLER
ROCKERY FIRE ALARM
CrYPE OF USE. BUSINESS OR ACTI�!MMPLAIN: I/
in ___7NUMBER OF CRITICAL
ui NUMBER
B AREAS
0 OFO I DWELLING
M NUMBER
0 STORIES UNITS
ST
D SC I
1� ESCRIBE WO TO BE DONE
oL
HEAT SOU�� GLAZING 51 LOT SLOPE %
PLAN CHECK 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.
PERMIT APPLICATION: 180DAYS
uj
CL PERL41T LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
W 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTERESF, 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 NAI URE, ARISING DIRECTLY OR INDIREC I I-Y
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
13 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
i Y WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
0 NOR LIMIT IN AN
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DUtY 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 V61-ATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIONINSURANCE AND RCW 18.27.
SIGNATUA (OVVJ"Rl�GE�I�T'*`? DATE SIGNED
1�pe B or L vent connectors
ENG114 urning applianWin
unheated spaces. UMC 815.1.2 -
DATE
FIRE 1EVIt!"
EXP
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EJERPT
ain.
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SHORELINE OR A111111 I INSREC N
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PROPOSED
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PARKING NNING REVIEWED BY DATE
REO'D I PROVIDED
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0 SS INS CTIONS PER UBC 108/FINAL INSPECTION REQI'D F3
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Description
Plan Check
Building Permit
plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Fire Review Plan Chk. Depowt
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Duel _7S
Recording Fee Receipt # L
APPLICATION APPROVAL
I his application is not a pannit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFFICIALS IGNAIrURE e DAYE
------ ---------- /7
(425)
14
771-0220 /DATE
FXT 13:33 1 .... .....
A I I =IVII IV" ILDING OR STRUCTURE UNTIL
IT IS UNLAWFUL TO USE OR OCCUPY A BU
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
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IIIIIIII:
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall.........................
Pior/Porch .................
Retaining Wall .....
z
0
Slab Insulation ..........
I
M
PLUMBING:
Underground ......
Rough -in ............. ......
M
C
M
Commercial f inal ......
0
0
HEATING:
I-vvi
C
M
L4 GasTest .................... ------- v__z___
M z
Gas Piping .................
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Equipment .................
Commercial Final .......
0 _n
EXTERIOR SHEATHING
M
NAILING ..........................
M
0 r
FRAMING ........................
0 M
C: CD
FIRST FLOOR FRAMING ...
Cn
Q 0
Z
INSULATION ...................
--I
Floor Insulation .........
;U
--I
Wall Insulation ...........
7:
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Ceiling Insulation .......
SHEETROCK NAILING ...
Cn
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0
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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