20040318.pdfI
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DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
ALKI- XeL i
MAILING ADDRESS 1j
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CITY
NAME
I CITY
ZIP I TELEPHONE
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ZIP ITELEPHONE
NAME CBL
ADDRESS
CITY
6fPMdx-V_�
ZIP
Ido3611
TELEPHONE
21-2
STATE LICENSE NUMBER
EXPIRATION DATE
HECKEIPBY
V
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11115
PROPERTY TAX ACC9UNT
PARCEL NO
t),r)-7
q.
11 NEW
kRESIDENTIAL
PLUMBING MECH
1 ADDITION
:1
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
E] REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING CYDS FENCE FT)
E] DEMOLISH
1:1
TANK
OT1 V
h5�
GARAGE
El CARPORT
E3
RETAINING WALL FIRE SPRINKLER
ROCKERY E] FIRE ALARM
(TYPE OF USE, BUSINESS ORAqTIVr[Y),ETPWN:
NUMBER NUMBCR 0
OF DWELLING
ct STORIES UNITS
DESCRIBE WORK TO BE DONE
'0.",
I A t7- e6r1r-1 Aj
HEAT SOURCE
PLAN CHECK NO:
GLAZING %
CRITICAL
AREAS
NUMBER
WO
Illiwow
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
CL PERMIT LIMIT; 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
in
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTtY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 _)N.
I NOR LIMIT IN ANY WAY THE CIr-rS ABILITY TO ENFORCE ANY ORDINANCE PROVISIL -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION: THAT HIE INFORMATION
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-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSUMNCE AND RCW 18.27.
SIGNATURE (OWNER 0141_46EV�/ DATE SIGNP
e.7
MI I I PERMIT EXPIRES
bsE PERMIT
ZONE NUMBER
JOB JITEIAP.T#
ADDRESS
0 Z, z
q
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO,
LID FEE S
TESCP AP.1roved 9
PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP
UBLIC RI I IT
8W Permit Required 13
Street Use Pormot Fleet'd [3
X ISTI G
EXISTING PROPOSED
rHFOUIRFD
Inspection Required 13
sidewalk Require d [3
-out DEDICATION- F1
Underground
Wiring required 0
ETrR SIZE
M M SIZ
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES 0 NO 13
REMARKS
OWNERICONTRACFOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDED
REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTION
REQUIRED [] YES
SIGN AREA HEIGHT
ALLOWED - PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR I FRONT LJR SIDE REAR
LOT AREA I PLANNING REVIEWED 13Y DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
0
W
z
z
5
z
W
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a:
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0
z
-2
z
REMARKS 1-5
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RW'Dd 3E
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VALUATION
$ I /I "q q 3 —
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION " 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-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
Description
State Surcharge4,
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
11,1-4
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
FFICJA�S SIGNATWE . I DATE I
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY f DA
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
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0
M
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M
C
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0
0
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M M
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9 cn
M 0
Z
71
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0
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
0
Retaining Wall ........... __4
Slab Insulation .......... M
PLUMBING:
Underground ............. 3:
0 M
C
Rough -In ... ................ M Q
0
__40
Commercial Final ...... 0 C
—4
HEATING: 3: M
M Z
--I
Gas Test ....................
_Z
--j
Gas Piping .................
Equipment .................
0 -n
-n
--I
Commercial Final ....... 3:9
EXTERIOR SHEATHING M M
0
NAILING .......................... 0
0 M
FRAMING ........................ C (1)
r. C0
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ................... ;U
--I
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation ....... Cf)
z
SHEETROCK NAILING ... 0
--I
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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