20040321.pdfDATE RECEIVED /.2
ERMIT EXPIRES
FP
USE PERMIT
ZONE -/_ 0 0
CITY OF EDMONDS NUMBER _5ZZL_
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
O%yNjR NAME/NAME OF BUSINEfS
Cke PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
4 14 e.,
Ivin.ri agn Keym I e4 ij e.,
M 'MAIL G ADDRES LID FEE S
Lu S
st- PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I ESCP Approved
FjW Permit Required E3
0 Street Use Permit Roq'd E3
�141 9 fl j od C3
CITY ZIP TELEPHONE EXISTING — PROPOSED inspection Requir
Sidewalk Required E3
underground
ty) 0 9 96 24 42 _5 `7 _7'-L-- 15 2-9 REQUIRED DEDICATION— FT Wiring required
L-T
NAME METER SIZE LINE NO. OF FIXTURES PRV REQUIRED
z
YES 0 NO 13 Fr
8 1 LU
Lu z
I- ADDRESS REMARKS z
x OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIORAINAGE a
U z
W
ZIP TELEPHONE
0 Permit froM
N C13L 0
SL-tezj�; ""._hidustn
DATE
n ereoj i, i 4-ej�i <,- ENGINEERIN 3 REVIEWED BY
cc ADDRESS
FIRE REVIEWED BY DATE W
cc
C I'lle 11 TELEPHONE M
TY
ZOLP- VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
PTE LICENSE NUMBER FXF )N DATE Y REO'D POSTED
_ DfL�)(fS'NZQ P 1-7-64 SEPA REVIEW SIGN AREA OYES ONO 1$ HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
W
EXP
L Mr'� ';(EUUIHE:tj CKS (FT.)
NEW RESIDENTIAL PLUMBING/ CECH) ALLO lj�PPBEb - RONT L/R SID: REAR
A E`NbnF6ozWct z
COMPLIANCE OR 2
ADDITION COMMERCIAL 1� z
1:3 CHANGE OF USE 1111411`11111tromd fin -. filpligh"-11
RkiNd LIOM�%jif q DATE
LOT AREA
REMODEL MULTIFAMILY [:1 SIGN REOID ram SpaC111, P
GRADING FENCE
REPAIR CYDS 1:1 ( x FT) REMARKS
DEMOLISH TANK 1:1 OTHER .
GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY 1:1 FIRE ALARM
(TYF1,fi-5FUSE.,BLjSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYP
M Eu;,VIN OCCUPANT
a (-,to GROUP
NUMBER OF Xrz,
'W N&NZER CRITICAL
AREAS SPECIAL INSPECTION JAREA OCCUPANT
LOAD
0 STORIES UNITS NUMBE
OF I DWELLING R REQUIRED [] YES
DESfOR E MORK TO BFVDPNE (\
A c 0 C-4 "A 0,6 REMARKS z
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D F3
=1
M
—f�\Px-m ro mn I±Ais
t\J0 M a rA-, VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
H URCE GLAZING % LOT SLOPE Building Permit City Surcharge
0.1 1
PLAN 10HECK NO: VESTED DATE Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical C)
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading CID
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
ul
91 PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
114 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
< ALL CLAIMS FOR DAMAGES OF WHATEVER NAI URE, ARISING DIRECTLY OR INDIRECTLY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Receipt # Z Lj
Recording Fee
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRLIC- CALL
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 WASH114GTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
SIGNA URE Y(WN R OR GEN DATE SIGNED (425)
It 19 f
_I RELEASED BY 1 DATE
�4 3 771 -Od-
71 )20
ATTENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
7
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW/INSPECIOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN ACCOUNTING
z
0
M
-n
M
C
M
0
C)
0 C:
M
M Z
04
C
M
Cl)
o -n
Fix
>
M M
0 5)
0 r_
0 ITI
C: Cl)
9 C0
M 0
Z
X
__4
z
--I
X
(1)
z
0
i
0
IT!
mi -
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
f UNe�qrour
Rougl��In ......
Com'mdrdal
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 000 6) 3 :1 / %/
z
0
1
0
IT!