20040288A.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
(f coov4j / Al(. /-/ 4
MAILING ADDRESS
47 if� 10 67 2 P
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP
TELEPHONE
[PERMIT EXPIRES
USE PERMIT
Z014E NUMBER
JOB SUITE!APT#
ADDRESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
LID FEE $
TESCP Approved
PUBLIC RIGIII OF WAY PER OFFICIAL STREET MAP FjW permit Hoquirod
Street Use permit Roq'd E3
EXISTING � PROPOSED inspection nequired [3
S,dew,11k Haquired 0
underground
REQUIRED DEDICATION- FT wiring rortuved 0
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 11 NO 13
REMARKS
OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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NAME CBL
V45R,51tr1_/ tg_ A9!10F/ AJ6 4:7� ENGINEERING REVIEWED BY DATE
ADDRESS
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STATE LICENSE NUMBER FXPIRAIIUN UAIt CHECKED 9Y VARIANCE OR CU SHORELINE OR ADB# REO'D POSTED
— I - 111YE CINOIS HT
vive 5-414z 10 2. SEPA REVIEW SIGN AREA HEIG opo
EXEMPT ALLOWED SED ALLOWED PH SED
PRO.P_ERTY TAX ACIOUNT PAaCEL NO. COMPLETE PROPO
EXP
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LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (IFT)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE HEAR FRONT URSIDE REAR L5
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COMPLIANCE OR
ADDITION COMMERCIAL CHANGE OF USE
E REMODEL MULTIFAMILY PARKING DED LOT AREA PLANNING REVIEWED BY DATE CL
13 SIGN REO'D I PROW
GRADING FENCE
REPAIR CYDS ( x F7), REMARKS
DEMOLISH TANK OTHERO
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
r (TYPE OF USE, BUSINESS OR ENITY) �XP480N: OCC
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uj NUMBER NOABER OF CRITICAL
a OF DWELLING AREAS SPECIAL INSPECTION AREA OCCUPANT
M STORIES NITS NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ1D
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VALUATION
$ C7�
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
j SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
Uj
06 PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 160 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Plan Chk. Deposit
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review
Lu IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
_j
21 EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NAIURE, ARISING DIRECRYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
13 3�15zq
_j DEEMED To MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt # 976
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED 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 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.
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WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. /'OFFIC-1119S NATURE E
G DATE :SYIGN -D
SIGNATURE (OWNER 0 (425)
7 771-0220 R 3TED BY
DATE
ATTiAbmif, E)ff 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
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 Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY .................. 4
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