20040327.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
F45C—N_Z�o
MAILING ADDRrss
1�518 PL SW
CITY ZIP I TELEPHONE
L:::: L) N 0-i"i IPS 91?6zo 1
NAME
ADDRESS
CITY
ZIP I TELEPHONE
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
PERMIT
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N U M B E R (),
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LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED --
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE NO. OF FIXTURES
LID NO
LID FEE $
I ESCP Approod
L3
RW Permit Requited
13
Street Use permit Req'd
13
inspection Required
13
S,dowalk Required
0
Underground
CI
Wiring lOqUifird
PRV REQUIRED
YES C3 NO 13
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
NAME CBL 4 ///
V t5 5,4rle
ENGINEERING REVIE
ADDRESS
C- FIRE REVIEWED BY
CITY ZIP TE.EPHONE
4&age/ oW
/
14ri 1 VARIANCE OR CU
STATE LICENSE NUMBER EXPIRATI N DATE CHECKED BY
"f 0
U Ic
PROPERTY TAX ACCOUNT PARCEL NO
— __ ) I . �/7% � J% ^
NEW
ESIDENTIAL
X—O
PLUMBING / MECH
ADDITION
r_�
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
X FT)
E]
DEMOLISH
El
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINE4S-PR ACTIVITY) EXPLAIN
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
T�r-SA6-6-1
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 1180DAYS
PERMIT LIMIT: I 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 INTEREST. AGREES TO INDEMNIFY, DEFEND AND 14OLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMI1. ISSUANCE OF 1 HIS PERMII SHAI L NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY's ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.*
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
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 INSURANCE AND FICW 10 27.
SIGNATURE (OWNER OR DAH: biLiNtL)
SEPA REVIEW
COMPLETE , EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
An
DATE
DATE
SHORELINEORADBO I INSPECTION PBOND
RE08 OSTED
0 Q8 NO S
OYES, NO S
SIGN AREA HEIGH'
PRO D LLO P
POSE ALLOWED PROPOSED
�WE
GN AREA HEIGHT
TALLO D . PROPOSED
a:
W
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LU
LU
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT Lin SIDE REAR
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2
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PARKING I LOT AREAJPL�ANNING REVIEWED BY DATE 01.
RED'[) I PROVIDED
REMARKS
�ONURUCTION CODE OCCUPAN
CHECKED BY VTY P - OF CON
GROUP
�HDAMT
SPECIAL INSPECTION JAREA LOAD
REQUIRED [:] YES
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION
$ 11) 17 �
Deicription
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt N
Total Amt. Due .3,?Zj?
Receipt N
APPLICATION APPROVAL
This application is riot a permit until signed by the
Building Olficial or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
rFIWL§ P1_GNhT41E DATE
ATTENTION - Lyt I I jjj
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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
M
Slab Insulation ..........
n
PLUMBING:
Underground ............. M
M
Rough -In ................... 0
0
Commercial Final ...... —4
M
HEATING: M z
C z
Gas Test .................... >
Gas Piping .................
0 -n
Equipment ................. _n r
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING .......................... 0 M
C Cl)
9 Cf)
FRAMING ........................
Q 0
Z r
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation ......... >
z
--I
Wall Insulation ...........
Cl)
Ceiling Insulation .......
z
0
SHEETROCK NkILING ...
SPECIAL INSPECTION' M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................