20040281.pdfI
DATE RECEIVED PERMIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER 22,nr
CONSTRUCTION PERMIT APPLICATION JOB E/APT#
ADDRESS e-
OWNER NAME/NAME 0 BUSIN SS
TLt-D PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
0C MAILING ADD ESS
U LID FEE $
I ESCP Approved [3
0 PUBLIC RIGH1 OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
CITY EXISTING — PROPOSED Street Use Permit Roq 0
zip Tri EP,)NE — inspection Required C3
sidewalk Required 13
Underground
REQUIRED DEDICATION� Fr
L 2
P)16,K,�E Wiring required [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO 13 z
ADDRESS REMARKS z
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E3 OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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CITY �V Y22A ui
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NAME a j CBL ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE W
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0
VARIANCE OR CU SHCRELINE 08 ADO# INSPECTION BOND
STATE LICENSE NUMBER CHECKED Y REO'D POSTED
I 3:J?,e 4JISIO& 1 , -1-) z- I I OYES ONO S
_j SEPI, REVIEW SIGN AREA HEIGHT
< PRO AqCOVNT_PARC 0 COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED PROPOSED
Ut EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR
COMPLIANCE OR z
ADDITION 2/cOMMERCIAL 1:1 CHANGE OF USE 2
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PARKING LOT AREA PLANNING REVIE ED BY DATE 5
REMODEL 1:1 MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
E] REPAIR 11 CYDS X—M REMARKS
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OTHER
DEMOLISH0.4D 17 TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF U E, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY ITYPE OF CONSTFIUCTI�0.) I OCCUPAI�
cyx GROUP OL->
NUMBER NUMBER 0 CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
ot STORIES UNITS NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE T— [I YES
REMARKS 0
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D Ej
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VALUATION
$
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Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge
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
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
LU PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR PADRE INFORMATION Engr. Inspection
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
In Fire Review Plan Chk. Deposit
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i IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
M Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC I I-Y OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
9 Recording Fee Receipt # .2,311-rV
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- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL building Official 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 C�0,�ATION INSURAU.GE�AND RC 111.27.
6 - OFFICIAL"JGNATUR� DAT
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DATE IG -�-u
(425) 4
771-0220
RELEASED BY DATE
A#EN N EXT 1333
IT Is Ui� L 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
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 .................
z
0
Retaining Wall ...........
0
Slab Insulation .......... M
PLUMBING:
Underground .............
IT!
Rough -In ................... 0
0
0
Commercial Final ...... C
M
HEATING: M Z
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GasTest ....................
Gas Piping .................
Equipment ................. 0 -n
n
Commercial Final ....... -
M M
EXTERIOR SHEATHING 0
NAILING.......................... 0
0 M
FRAMING ........................ C/)
Cn
Q 0
FIRST FLOOR FRAMING ... Z
71
INSULATION ................... ;a
--I
Floor Insulation .........
z
Wall Insulation ........... --I
Ceiling Insulation .......
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR 01 —
OCCUPANCY ..................