20040312.pdfDATE RECEIVED � —.1
=PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAMEMAME OF BUSI�E - SS
cc tle�l, z 15 PLAT NAMEISUBDIVISION NO LOT NO. LID NO
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MAILING ADDRESS LID FEE $
TESCP ApproVed 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required Q
03. ) )J/ q- A, &,�E street Use Pormit Req'd E3
CITY ZIP TELEPHONE EXISTING — PROPOSED Impection Required [3
Sidewalk Required 0
REQUIRED DEDICATION- FT undeiground
9z) s' 7 71 - LZI, Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
YES 13 NO 13 z
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t: ADDRESS REMARKS z
OWNEHICONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE E5
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CITY ZIP TELEPHONE
NAME ICBLN
ENGINEERING REVIEWED BY DATE
ADDRESS
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FIRE REVIEWED BY DATE uj
k L;IIY ZIP TELEPHONE cc
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1 - f/ I SHORELINE OR ADB# i INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE LCKED BY 4'C'fi 1 0 REQ: POSTED
03.. 1!; 6 1
i YES RNO S
--- SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED I PROPOSED ALLOW91) PROPPSED
*2 K IV14 1 /V/A
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NEW AF ESIDENTIAL PLUMBING I MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (IT)
ALLOWED Ppo OSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL E
CHANGE OF USE lvl,4 z
PARKING ji LOT AREA I P NNING REVIr-WED BY DATE 5
REMODEL MULTIFAMILY SIGN RID I PROVIDED 0 QL
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GRADING FENCE VA61
REPAIR CYDS ( � X FT) REMARKS
DEMOLISH 1:1 TANK o OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED OF C TRUCTION COD OCCUPANT
GROUP
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to OF DWELLING ARIEAS SPECIAL INSPECT N JAEA OCCUPANT
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ci STORIES UNITS NUMBER 61 REQUIRED
DESCRIBE WO D BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ'D FS
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Description
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK.NQ.- — . I VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
0
�I IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC FLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
_j DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREIAENT OF ANY CITY ORDINANCE
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,'
FEE Description
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0 State Surcharge
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City Surcharge
Base Fee
FEE
Plan Chk. Deposit K12,�w .1
Receipt #
Total Amt. Due
Receipt #
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 APPRO
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE IAWS 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 COMPENSATION INSURANCE AND RCW 18.27.
OFFICIAl S SIGNATURE DATE
SIGNATURE -(OW OR A T) DATE SIGNED (425)
771-0220
REL�ASI D BY DATE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
ATTENTION EXT 1333
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YE'LLOVINSPZCTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09fO3 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ........... 0
M
Slab Insulation ..........
PLUMBING:
0)
Underground ............. M
C
0
Rough -in ................... 0
0 C
Commercial Final ......
M
HEATING: M Z
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Gas Test .................... >
Gas Piping ................. co
0 _n
Equipment ................. _n
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING .......................... 0 M
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FRAMING ........................ Q 0
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FIRST FLOOR FRAMING ...
M
INSULATION ...................
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Floor Insulation ......... >
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Wall Insulation ...........
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Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
0
SPECIAL INSPECTION M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
..................
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