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20040341 (2).pdfI ATE RECEIVED USE CITY OFEDMONDS /.ONE JOB CONSTRUCTION PERMIT APPLICATION ADDRESS OWNER NAME/NAME OF BUSINESS MAILING ADDRESS CITY ZIP NAME ADDRESS 0 cr ZY' CITY ZIP 77 J NAME */z I El rIPHONE �;,rzj S(-) I T-f: 6 00 TELEPHONE -5- 70 CaL P --rn ,cc ADDRESS 0 r) X./52i`/6 � CITY TELEPHONE L) -0 ,z'p .2,1 STATE LICENSE NUMBER EXPIRATION DATE . / . 1, � OL PROPERTY TAX ACCOUNT PARCEL N 0. U-1 'En NEW El RESIDENTIAL ADDITION COMMERCIAL REMODEL MULTIFAMILY REPAIR GRADING CYDS F-1 DEMOLISH M TANK o GARAGE RETAINING WALL z CARPORT ROCKERY I r (TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: tu 0 NUMBER NUMBER OF M OF 3 DWELLING I -Z / o STORIES UNITS DESCRIBE WORK TO BE DONE IPERMIT EXPIRES ZZ"I 1111131111111111111 PERMIT .1V NUMBER 4.fflll - A�" SUITE/APT# PLAT NAME/SUBDIVISION' NO LOT NO LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I ESCIP Approved RW Permit I'loquired street use Permit Roq'd EXISTING — PROPOSED inspection Required Sidewalk Required REQUIRED DEDICATION— FT Undworound wiringrOqUirod METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED .2, If 17- ii I I ZI z YE S/K NO 13 REMARKS OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY /Z FIRE REVIEWED BY DATE VARIANCE OR CU SHORELINE OR ADS# INSPECTION I BOND CHECKED BY] I REO'D POSTED iwgD MECH COMPLIANCE OR CHANGE OF USE SIGN FENCE ( — X FT OTHER FIRE SPRINKLER FIRE ALARM CRITICAL AREAS NUMBER V 9L_ -45 _ro r— h-11 P / iil�7/ -t-e-7 r z UJI W IE]YES, ONO S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP I I LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT QRSIDE REAR z E z PARKING LOT AREATTEZNING REVIEWED BY DATE REO'D I PROVIDED nam.- qzllci CHECKED BY F T LIC N WO OCCUPANT GRO U�)7elk SPECIAL INSPECTION AREA OCCUPANT REQUIRED [ _] YES LOAD REMARKS z PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3 VALUATION 7j Zj 10" Description FEE Description FEE % State Surcharge rxKkt 2, �\k:� 1- Plan Check HEAT SOURCE GLAZING % t OT SLOPE % Building Permit City Surcharge PLAN CHEC'f NO- VESTED DATE Plumbing Base Fee LMechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE SEPARATE PERMISSION. Engr. Review W PERMIT APPLICATION: 180DAYS CL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION in Fire Review U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Plan Chk. Deposit W A _j IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HAW LESS THE CITY OF 2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt # ir I IR I ALL CLAIMS FOR DAMAGES OF WHAIEVER NArURE, ARISING DIREC TLY OR No EC LY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF rHIS PERMIl SHALL NOI 13E R E Landscapelnsp, Total Amt. Due DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CIFY 0 DINANC- 0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- x Recording Fee Receipt # I HEREBY ACKNOWLEDGE IIIAT I HAVE READ THIS APPLICATION ' THAI THE INFORMATION GIVEN IS CORRECT. AND THAT I AM THE OWNER, Oil THE DULY AUTHORIZED AGENI OF APPLICATION APPROVAL THE OWNER. I AGREE TO COMPlY WITH CITY AND STATE LAWS REGUI-AlING CONSIRUC CALL I his application is riot a permit until signed by tire 11ON AND IN DOING THE WORK AUTHORIZED TliEREBY. NO PERSON WILL BE EMPIOYFD Building Olficial or lusihor Deputy and Fees are paid, and IN VI'6LATION OF THE LA130R CODE OF THE STATE OF WASHINGTON RELATING To FOR INSPECTION receipt is acknowledged itt!,paco provided WORKMEN'S COMPENSAT!g�SIJ RANCE AND RCW III 2T OFF)CIA j-S-5;IGNA' �)f OATE SIGNATURE (OWNER OffAhENT)y DAIE SIG7D (425) 771-0220 DAl E FASFD 13Y ATTIfNTION EXT "1333 4 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING Oil STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL FILE YELLOW IW�PF-CTOH CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD-ASSESOOR 09"03 PRESS HARD -YOU ARE MAKING 4 COPIES z 0 i 0 M --i -n M M 0 0 0 C: M M Z 0­1 C o -n 171 M M 0 5) 0 r- 1711 Cn M 0 Z 7-1 r z --A 3: Cn z 0 1 0 ITI , M RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing ...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. -in ..... Rough .............. 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 4 0 M --i -n M rn 0 0 0 0 C M M z C 0 -n n M M 0 0 M C (n C Cf) M 0 Z r— M z W z 0 -1 0 M