20040346.pdf0
DATE RECEIVED
P ERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE (,"7 NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESSW) 11,11r-51- &1ex17,rx-,)
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LID FEE S
W MAICING ADDRESS
z TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required E3
10: 57- 5�� Street use Permit Rocid 0
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required 13
Sidowall, Required [3
underground
je0114,0A 4-125 717�1-5_11 REQUIRED DEDICATION— FT Wring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
YES NO z
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t: ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
W
CITY ZIP ITELEPHONE
NAME C
1?y5]5bEz_ 512*14NO INEERING REVIEWED BY DATE
ADDRESS
0
FIRE REVIEWED BY DATE Sit
CITY ZIP TELEPHONE
0
9460 7V10 VARIANCE OR CU SHORELINE OR ADBI INSPECTION BOND
44401�lp 72��_
STATE LICENSE NUMBER if. ION DATE CHECKED By RECI�D.. POSTED
JA 111 . OYES NO S
901�5_ 1 SEPA REVIEW SIGN AREA I HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWE PROPOSED ALLOW P OPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LiRSIDE REAR
COMPLIANCE OR
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ADDITION COMMERCIAL CHANGE OF USE I z
1 5
2�_c PARKING LOT AREA G REVIEWq0PY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
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GRADING CYDS FENCE I—,- :?n
REPAIR x FT) REMARKS I
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DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
�:: (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
rL CHECKED BY ITYPE OfGONSTBUC ION CODE OCCUPANT
GROUP
[77
13 NUMBER NUMBER OF CRITICAL OCCUPANT
OF DWELLING V� AREAS SPECIAL INSPECTION JAREA
i� LOAD
o STORIES UNITS NUMBER REQUIRED
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D 5
at
)V1 Lxl)� VALUATION
< $
/ 1 1,11411, Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % City Surcharge
I Building Permit
PLAN CHECK IS 7 VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
i DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
Lu
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'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 :A
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.- Recording Fee Receipt #
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS 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 011icial or hisitier 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.
/ 10F ICI - S SIGNAT HE DATE
SIGNATURE (OWNER C�l �VEN,�l DATE SIGNED (425)
771-0220 01 ED By
9 .1/ 55
ENTION EXT 1333
IT IS UNLAWFUL TO �SE R OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTIO -Ijx) BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - Fit F YELLINV - INSPECTUH
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch
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.................
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
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Underground .............
rT, 0
0
Rough -in ...................
0
0 C
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping .................
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Equipment
.................
Commercial Final .......
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EXTERIOR SHEATHING
0 M
NAILING ..........................
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FRAMING ........................
fn 0
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
0
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SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................