20040234.pdfM
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DATE RECEIVED .7 -1 PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS
W.4 AIg Z C 6 0 MAT NAME/SUBDIVISION NO LOT 140 LID NO
MAILING ADDRESS
U LID FEE
TESCP Approved 11
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Fjvv Pomil! Hfiquiled 13
0 2L�y mo �e: Street Uso ponnot Huq'd 13
CITY ZIP TEI EPHONE EXISTING — PROPOSED Impection fleqwfed 13
Sidowall, Floquired 0
II9IIq--0-21�r 2ro& REQUiHED 13EDiCAIION— FT Underground
witing roquirud 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
>9p NO 0
I c)T/ s YES
L— ADDRESS REMARKS z
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OWNER/CONTRAClOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
2 44 TV mt-r &J, A Uj
CITY ZIP TELEPHONE
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NAME C13L
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L-E, T, Cokr�T, J)95 1&d 9""Ir A 1 DATE
Cr ADDRESS YO
'2� )_ 2- 67 Z/
cc FIRE REVIEWED BY DATE Uj
!E CITY ZIP TELf PHONE cc
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U_ MWJL,-�,-,0 M-5 1 356� 0 29 SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIR TION DATE [---f HECKW BY VARIANCE OR CU REO'D POSTED
COD ik' 7a 1 00 j I OYES ONO I S
i tole Z/ SEPA REVIEW SIGN AREA HEIGHT
j P ACCOUNT PARCEL NO. COMPLETE
< ROPERTY TAX V EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
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§ 0 057 C -5 7 00.2 0 1.2 0 (1) EXP
NEW SSIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
V__4a 1:1 ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL y
El CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING FENCE I I -
REPAIR CYDS ( X FT) REMARK
DEMOLISH TANK OTHER tA`�A?( /70't/,
d /
11fe zil 6/-y 151cleel
RETAINING WALL FIRE SPRINKLER
E:i GARAGE
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR A I ITY) EXPLAfN: 1z1P&1e<41
L 0 J�j
RE CHECKED BY ITYPE OF CONSTRUCTION CODF OCCUPANr
O-za"(1 9.7 GROUP
MAT74L VeM -P
Lu NUMBER NU03ER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA
OCCUPANT
o STORIES UNITS NUMBER REQUIRED [] YE LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
D��p R 0 Or 50 U cjVkt;
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9,11 Af VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit Ico City Surcharge
CK NO: VESTED DATE Plumbing Base ee
Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
cc
W PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
cn 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review
En Plan Chk. Deposit
ul IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CIrY OF
—A
M- EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir Fire Inspection Receipt
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
0 NOR LIMIr IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION `7
0 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
=1 Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT THE INFORMATION I
GIVEN IS CORRECT, AND THAT 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- This application is not a perinit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building 011icial or his/her Deputy. and Fees are paid, and
!kl VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
RKMEN'S COMPEN�gkON INSURANCE AND RCW 18 27. OFFICIA1 S SIGNATURE DATE
ATURE (OWNER A ENT DATf S)bNE (425) _a�, -31 -,0 -<z
771-02�20,1_
RFI ��<F"Y D E
`sF7,y . . ... 7
4 SP
ATTENTION EXT 1 33
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
ORIGINAL FILE YE1LOW IN(SPECT R
it'
CATE OF OCCUPANCY HAS BEEN GRANTED. LIBC SECTION 109 PINK -OWNER COLD ASSESSOR
09/03 PI S
PRESS HARD -YOU ARE MAKING ?4PIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
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 ..................
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