20040263.pdfDATE RECEIVE
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NaIUAME OF BUSINESS
.) o
MAIL ING ADDRFS S
64,-3
CITY .... �zip TELEeHONE
"'li
y 0 -2, 7 7 6 e/ "�;'
NAME
ADDRESS
CITY ZIP [TELEPHONE
NAME
ADDRESS
kz'
ZIP TELEPHONE
STATE LICENSE NUMBER VArir
PROPERTY TAX ACCOUNT PARCEL NO.
-' ;700
NEW Zj,,,R'ESIDENTIAI_
ADDITION E] COMMERCIAL
REMODEL MULTIFAMILY
E:] REPAIR D GRADING CYDS
DEMOLISH TANK
171
GARAGE E:i RETAINING WALL
ROCKERY
CARPORT
(TYPE OF USE. BUSINES�,Oil ACTIVITY) EXPLAIN:
S t=_ -) L
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
n4 *4_ I I
kT SOLIFICE GLAZING %
�z _ I
CHECK NO:
CBL#
(417
WPLUMBING
MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
El
FENCE
Fr,
X
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
for SIOPE %
VFSIFO 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: 1180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS Oil HER SPOUSF. HEIRS, ASSIGNS AND SUCCFSORS
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND IIOtD 11ARMiFSS 114F CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGFNIS F140M ANY ANL)
ALL. CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING EiIRFCIIY Oil IND111rCTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAI I NOT LIF
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY OREIINANCF PROVISION '
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, IIIAT IIIE 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 REGULAIING CONSIRUC
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON Wit L BE EMPLOY 1:1)
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18-27
DATV JIGN
ERMIT EXPIRES
I -P, -1 FP MMMMMMMOMMO�
USE PERMIT
ZONE *� 0&
NUMBER 71
JOB
ADDRESS - t
e 3 0e]
PLAT NAME/SUBDIVISION NO
SUITE/APT#
4,
0:3 f Pk
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED OEDICATION� Fr
METER 31ZE LINE SIZE NO. OF FIXTURES
is open or close. -I., expansion t
req&ed on all hot water tanks
Ulk-Go-de. ECDC 19.30.020 (c)
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
ffil" Mw
#
LID NO
LID FEE $
TESCP App(oved
nW Permit Required
Street Use Permit Roq'd
inspection Required
Sidewalk Required
underground
wiring required
PRV REQUIRED
YES 13 NO E3
DATE
SIGN AREA HEIGHT
ALLOWED . PROPOSED ALLOWED , PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
I PLANNING REVIEWED 13Y
LOT AREA
CHECKED By ITYPE OF
SPECIAL INSPECTION AREA
REQUIRED [] YES
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
W
z
z
6
z
W
Uj
0
z
2
z
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F,
VALUATION
A - -..-41
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
FEE Description
State Surcharge
City Surcharge
7TBase Fee
CALL
FOR INSPECTION
(425) 0
771-0220 —R
FEE
Plan Chk. Deposit
Receipt #
0
Total Amt. Due
12
.2
Receipt # C/
APPLICATION APPROVAL
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 pr4ided.
ATTENTION I/ EXT 1333
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 r- e%
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
L-Fil
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
0
M
M
C 0
M 0
--1 0
0 C
M
M Z
10 --1
C:
>
r-
W
0 _n
_n
x
M M
0 5i
0 r-
0 M
C (/)
9 (n
M 0
Z
7_'
X
--I
>
z
Cn
z
0
A
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wafl ........... 0
0
Slab insulation .......... M
PLUMBING:
Underground .............
M
c::
Rough -In ................... 0
M 0
Commercial Final ...... 0
0 C:
HEATING: M
M Z
Gas Test ....................
C
Gas Piping .................
Equipment ................. 0)
0 -n
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING ........................... 0
0 ITI
FRAMING ........................ C 0)
9 0)
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ................... M
Floor Insulation .........
>
Wall Insulation ........... z
--I
Ceiling Insulation ....... :C
V5
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
2o0qav 0