20040311.pdfI
IVED [PERMIT EXPIRES
LJSE D9:0"IT
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSI
ly�k WliitkWU4t/_
T
SS
KVAII,4tcAn�
M
W
MAILING ADDRESS
z
30'
( V O�A- 0 [1," U
CUIR,
CITY
ZIP 1
T LEPHONE
i
6 2<,,)
oo
NAME
ADDRESS
U
CITY
ZIP
ITELEPHONE
0_71
ZONE 'I A
NUMBER
JOB SUITE/APT#
ADDRESS
Qs -oe
PLAT NAME/SUBDIVISION NO. LOT NO� LID NO.
LID FEE $
TESCP Approvnd [3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Peftnit Required 13
Street Use Parinit Roq'd 0
EXISTING — PROPOSED
inspection Requited EI
Sidawalk Requliod [3
REQUIRED DEDICATION— FT
Underground
Wiring required 13
METER SIZE
LINE SIZE
I
NO. OF FIXTURES
I
PRV REQUIRED
YESO NO 1:1
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
z
6
z
LU
NAME CBL 00
-7� ENGINEERING REVIEWED BY DATE
D I IC AA COKr%:—lot
ADDRESS
1 19 2— FIRE REVIEWED BY DATE tu
M
CITY ZIP TELEPHONE M
A(Lu2eaja4 'Is q 3 VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICEN9E NUM13ER EXPIRATIO14 DAIE CH -REEIN REO'D POSTED
3) OYES E]NO S
* 052.V<3 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. V COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
d19 /1// 1,714 /9 /9 /'/o 12 8�0 0 EXP I —
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
El NEW RESIDENTIAL [B-I'LUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR z
z
F� ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
CL
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS I I I X FT) REMARKS
DEMOLISH TANK 1:1 OTHER
oGARAGE RETAININGWALL FIRE SPRINKLER
CARPORT ROCKERY 0 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY jCTION OCCUPANT
Avic;lul St L14 A6 CeWL-Al 0 Wf*t CC—, TYMAX' GROUP
NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPE N]AREA OCCUPANT
NUMBER UNITS NUMBER REQUIRED LOAD
STORIES YES
DESCRIBE WORK TO BE DONE 0
REMARKS z
PROGRESS INSPECTIONS PER UBC JOB/FINAL INSPECTION REG-D 5
ca
ltvle�k-
VALUATION
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
'-- . -1 � Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
E
c PERMIT APPLICATION: 180 DAYS
U
L PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER 33POUSE. HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
U IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
J
E EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
r ALL CLAIMS FOR DAMAGES OFWHATEVFR NATURE, ARISING DIRECTLY OR INDIRECTLY
C FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
-1 — —
3 NOR LIMIT IN ANY WAY'THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
r Recording Fee �±Receipt H
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 ad by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until sign
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building ollicial or his/her Deputy: and Fees are paid, and
IN V61-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION- INSURANCE AND RCW 18.27. 7E
OFFICIALS SIGNAT
JPRE D�
DATE,ISIGNEDj
SIGNATURE (OWNER 0 v
LAGENT (425)
REGASED BY DATE
771-0220
ATTENTION I — -----
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
z
0
1
0
M
--I -n
M
C
M
0
--I (-)
0 C:
M
M Z
_z
Cn
0 711
n
M M
0 6
0 r_
0 M
C C0
9 Cn
Q 0
Z
z
Cl)
z
0
M
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 ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
0
M
0
0
0 C
-4 K
= M
IT! Z
C
:C
0 _n
n
M M
0 C-1)
0
0 ITI
W
M 0
Z
>
z
--I
C/)
z
0
M