20040237.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINE6S
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ILL MAILING ADDRESS
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CITY ZIP TE EPHONE
NAME
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ADDRESS
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CITY ZIP HONE
NAME C !13!L� 4
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ADDR SS
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CITY ZIP
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TELEPHONE
STATE LICENSE NUMBER
ILI '611; ,
EXPIR TION7ATI]i
CHECH
PROPERTY TAX ACCOUNT PARCEL NO.
W
12- 0//e -06
1:1 NEW D-IRESIDENTIAL
PLUMBING MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
a-R'EMODEL MULTIFAMILY
SIGN
REPAIR GRADING FENCE
CYOS ( X
DEMOLISH TANK
F1 OTHER
E:iGARAGE E] RETAINING WALL FIRE SPRINKLER
CARPORT ROOKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACPjM EXP
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NUMBER
OF
NUMdER7OfF
DWELLING
CRITICAL Vvc7r
AREAS
0
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
LOT SLOPE %
USE
ZONE
PERMIT EXPIRES 21 1
PERMIT
NUMBER
JOB
ADDRESS
9-M
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PLAT NAME/SUBDIVISION NO
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I
TESCP Approved
RW Permit Required
0
13
Street Use Permit Roq'd
E3
EXISTING - PROPOSED
inspection Required
13
Sidewalk Required
E3
REQUIRED DEDICATION-- FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES 11 NO 0
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVI
FIRE REVIEWED BY
M.
DATE
DATE
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LU
9
7M
BY
VARIANCE OR CU
SHORELINE OR ADB#
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REO'D
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POSTED
Is
]INYSPECTION
ES [�
S EPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED SED
PROPO
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LOT COVERAGE
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REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
1
132-
z
-2
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
P OV
REO'D R IDED
11.
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FIT) I REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION JAREA
REQUIRED [:] YES
OCCUPANT
GROUP
OCCUPANT
LOAD
IREMARKS 0
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PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D 19
fs :3
103
PLAN CHECK NO: Lj 0 g ( I I VESTED DATE
-III -
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Cr
W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. 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 NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S ABIL11Y 10 ENFORCE ANY ORDINANCE PROVISION. -
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
TION; 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
WORY,MEt4*-GQMPENSATION INSURANCE AND RCW 18.27,
SIGNATUR HoWER R AGENT),,e�,/ DATE SIGNED
_3
VALUATION
$ /9 / .4
Description
Plan Check
Building Permit_
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE
Description
FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit 14L, C/
Receipt III
Total Amt. Due
Receipt #
APPLICATION APPROVAI
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
OFFICIALS SIGNATURE DATE
RELEAS1711) BY nAT J
ATTENTION E)ff 1 3�'
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 CO IES
ORIGINAL - FILE YELLOW - idEcto
PINK - OWNER GOLD - ASSESSOR
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0
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M 0
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION -
Footing ......................
Wall ..........................
z
Pier/Porch ................. 0
—4,
Retaining Wall ........... 0
M
Slab Insulation ..........
-4 -n
PLUMBING:
3:
Underground ............. M
C:
M
Rough -In ................... --1 0
0
0 C
Commercial Final ...... K
M
M Z
HEATING:
C: _Z
Gas Test .................... >
r 3:
Gas Piping ................. 0)
o -n
Equipment ................. n
Commercial Final ....... M M
EXTERIOR SHEATHING
0
NAILING .......................... 0 M
C: Cn
(n
FRAMING ........................ M 0
Z
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... >
z
Wall Insulation ........... 3:
Cn
Ceiling Insulation ....... z
0
SHEETROCK NAILING
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
2 0237