20040279.pdfDATE RECEIVED
:yz/ C/ [PERMIT EX 0 PIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/NAME OF BUSINESS Z�4 7
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PLAT NAME/SUBDI\f1SION NO. LID NO.
MAILING ADDIlESS z LID FEE $
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z I ESCIJ Approved 11
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rw Permit Required 0
0
14 inspection Roquir 13
Street Use Permit Roq'd [3
CITY zip TELEPHONE EXISTING - PROPOSED ad
I Sidewalk Required 13
REQUIRED DEDICATION. FT underground
e 7, 5) -7 7c". 3 - 3 Wiring required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
YES NO z
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L— ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBI. FOR EROSION CONTROL/DRAINAGE Z5
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1242 J,/ '4� ENGINEERING REVIEWED BY DATE
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71 e��e740-7 -7 >�— d-f vi�- V VARIANCE OR CU SHORELINE OR ADBP INSPECTION BOND
SE NUMBER EXPIRATION DATE QIjECKED Y REQ'D POSTED
r.2A Y /Q / 1:1�qe 4yelie�,4-y SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
ACCOUNT PARCEL NO.
PROPERTY TAX COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED I PROPOSED
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NEW RESIDENTIAL PLUMBING i MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR
ADDITION F� COMMERCIAL z
E] CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
*EMODEL MULTIFAMILY 11 SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS 1:1 ( X FT) REMARKS
DEMOLISH TANK 1:1 OTHER
Ei GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 13 FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY ITYPEPIO #y OCCUPANT
GROUP
tu NUMBER NUMBER OF CRITICAL
OF DWE LLING AREAS SPECIAL INSPECTION ATIE OCCUPANT
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DESCRIBE WORK TO BE DONE
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7 VHUIIJHt:bb INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 2i
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VALUATION
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au Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing CJ Base Fee
Mechanical
THIS PERM;T 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
UJI PEnMITAPPLICATION: 1180DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERL41T FOR MORE INFORMATION
U) 'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
U)
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS *THE CITY OF
2 EDMONDS, WASHINGTON, I is OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
a:
ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY Oil INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFI� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION.'
MI Recording Fee LReceipt #
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 APPLICATION APPROVAL
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 EMPLOYEE) Building Olficial or his/her Deputy: and Fees are paid, and
IN VI'6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space proviged.
WORKMEN'S COMPENSATION INSURANCE AND RCW IE1.27. r
1_�_ FV IGNATUF/V,
SIGNATU��O�R GEN DATE SIGNED OF J��h S"S "
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771-02211--
EASED BY
A
AT ION 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- ORIGINAL - FILE - YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
W03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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Retaining Wall ...........
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Slab Insulation ..........
PLUMBING:
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Rough -in ...................
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Commercial Final ......
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HEATING:
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Gas Piping .................
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Equipment
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
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INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................