20040256.pdf13
F�ATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
10
CITY CIZIP ITELEPHONE
C7
NAME
L— ADDRESS
CITY ZIP TELEPHONE
NAME
CBL #
PERMIT EXPIRES
- I
USE PERMIT
ZONE NUMBER
JOB
ADDRESS C, L 5 'T
PLAT NAMEISUBDIVISION NO I LOT NO
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
HEQUIRFD DEDICAIION� FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
suiTE/APT#
LID NO
LID FEE $
TFSEP Applolf",
FjW P"Injit ROCIU11f1d
Street jjS, pormit Fjoq d
inspaction Hocinaod
Sldowatk Roquifed
Undolground
wifing toquirad
PRV REQUIRED
YES 0 NO IJ
REMARKS
OWNFR/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
SHALL BE INSTALLED NEAR
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ENGINEERING REVIEWED 13Y I'JIFFDATE
ADDRESS
FIRE REVIEWED BY
CITY
ZIP TELEPHONE
9go la5
71
7 7LI3
3366)
VARIANCE OR CU
STA�E LICENSE NUMBER
EXPIRATION
DATE CjJFCKED BY
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X leil-4A
P_
SEPA RE� IEW
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE
oo 5 9; el 0
(f) 0 ;Z QOE &
EXP I
NEW
RESIDENTIAL
PLUMBING MECH
_ —
LOT COVERAGE
ALLOWED PROPOSED
ADDITION
E] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
PARKING
15� REMODEL
MULTIFAMILY
SIGN
REQ'D I PROVIDED
L---
11 REPAIR
--------
GRADING
CYDS
FENCE
L X Fr)
REMARKS
11 DEMOLISH
TANK
OTHER
EiGARAGE
CARPORT
RETAINING WALL
FLOCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSJNE�SS OR ACTIVITY) EXPLAIN:
1.::;.4 ) 7—/ Al- /
CHECKED By TYPE a
I r,
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER 121
DESCRIBE WORK TO BE DONE
M/')1"j-_ PLtf,1,10�1146 Lo c,4,7— ( c)
1-1
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: ISO DAYS
Uj
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 1130 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPI.ICANT, ON BEHALF OF His OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
W IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMI-ESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIAI-S, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTI-Y
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IHIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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19 NOR IAMIT IN ANY WAY I HE ciryS ABILITY TO 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 DUIY 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
WORKMEN'S COMPENSATION �LRANCE AND RCW 18,2T
(OWNER 0 NT)' DATE SIGNED
S '.1 1 t , .1 __ 1r7 Aricie- 2oo-Y
DATE
SHORELINE OR ADBI I INSPECTION PBOND
OSTEO
REO'D STED
OYES ONO L$
SIGN AREA HEIGHT
F-ALLOWED . PROPOSED I ALLOWED , PROPOSED
13
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REQUIRED SETBACKS (Fr.) I PROPOSED SETBACKRS.A(FE)
FRONT SIDE REAR FRONT UR SID E R
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LOT AREA I PLANNING FIEVIE;�ED By DATE CL
OCCUPANT
!OUP
!iA
SPECIAL INSPECTION AREA OCCUPM14 I
LOAD
S
SP QUIRED [] YL
RE ES
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[FRIEMARKS 'D
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PF OGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REG F2
PURSUANT TO UPC 605.2 M
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
AS IT E-WERSTHE BUILD
FEE Description FEE
State Surchargle
rg
Ircha e
City Surch rge
1.0
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
'3 02 r"
Plan Chk. Deposit
eceipt #
EEE
T Tot I mt Ue
otal Amt. Due
EIR
Receipt #
APP ION APPROVAL
This application is not a permit until signed by the
Bmiding Official or his/her Deputy: and Fees are paid, and
receipt is acl%nowledged in space
provided.
FFIqlAIS SIGNAL YRE
DATE
Ft EASED BY
)�ATE_
ATTENTION FZA 1
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 COPIES
0141GIIJAL FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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171
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground.............
Rough -in ................... f—y") h _t
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRS17 FLOOR FRAMING...
INSULATION: ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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