20040245.pdfI
DATE RECEIVED
A t AMC a A I =I*] 2! 1 * 9
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PERMIT EXPIRES
USE PERMIT
ZONE /9 IN U M B E R
JOB SUITEIAPT#
ADDRESS
I 'I Kl, PLAT NAME/SUBDIVISION NO. LOT N6. LID NO.
MAXrNG ADDRISSS.) LID FEE $
z TESCP Approved 0
3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Roquirild [3
0 ni. I?rj Street Use Permit Roq'd 13
CITY IEPHONE EXISTING — PROPOSED Inspection Required 0
ZIP TE Sidewalk Required E3
REQUIRED DEDICATION— FT Underground
Wiring required 0
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
YES IJ NO 13 z
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t: ADDRESS REMARKS z
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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CITY ZIP TELEPHONE IType B oi- L vent contiectors rcquired
oil fliel-burnill" appliances passing
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FIRE REVIEWED BY DATE W
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CITY ZIP TELEPHONE W
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
a-VM!Eyn-ToQ�zQ�2 a SEPA REVIEW SIGN AREA OYES ONO HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
#f-NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR 0
06 COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE
10 PARKING LOT AREA I PLANNING REVIEWED BY DATE
13 REMODEL MULTIFAMILY SIGN REO'D I PROVIDEG S I -EST MUST BE
GRADING FENCE _fY INSPECT R
1:1 REPAIR r. Y I) ( — x FT) REMARKS U56thVED BY GI
E3 DEMOLISH El TANK OTHER AFFIDAVITS SHALL NOT
o GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM BE AUGEP110
(TYPE OF USE, BUSINF,9� OR ACTIVITY) EXPLAIN:
CHECKED BY I TYPE OF CONSTRUCTION CODE OCCUPANT
GROUP
YES
NUM13ER NUMBER OF CRITICAL
OF DWELLING if AREAS SPECIAL INSPECT104 AREA OCCUPANT
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0 STORIES UNITS I NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION RECI-D
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VALUATION
14
Description FEE Description FEE
Plan Check State Surcharge
CAT 0 CE GLAZING % LOT SLOPE %
Building Permit city Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W 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
cn 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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9 IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt ft
< ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY 717-
31 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
93 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE andscapelnsp. II Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE VtjUV1b1UN
x I Recording Fee Receipt 0
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT. AND THAT I AM THE OWNER, OR T1 IE DULY AU7 HORIZED AGENT OF
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 Olficial 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.
I - OrFIC ALS SIGN4TURE DATE
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SIGNATURE (OwNE AGEhT DATE Sl YED (425)
7 -0220 DATV
71 RELEASED BY
ATTENTIION EXT 1333 -------------
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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:
....................
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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