20040353.pdfCEIVED
DATE RE PERMIT EXPIRES x,
USE PERMIT
CITY OF EDMONDS ZONE N U M B E R —,IQ
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APTf
ADDRESS
OWNER NAME/NAME OF BUSINESS,'l Jz/
PLAT NAMEISUBDIVI�ION NO. L 0 T�k. LID NO.
MAILING ADDRESS ...
W
z LID FEE $
3: 7ESCP Approved 13
0 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required 13
CITY Street U50 P011'eit Flaq'd 0
k ZIP TELEPHONE EXISTING PROPOSED inspection Required
9 Sidewalk Roquired
REQUIRED DEDICATION— FT Underground
Wifing required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 0 NO 13 z
lu FE
I I Lu
t ADDRESS REMARKS z
z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
0,
W
CITY ZIP ELEPHONE
NAME
ENGINEERING REVIEWED BY
DATE
ADDRESS
0
C,,
FIRE REVIEWED BY DATE ul
CITY ZIP TELEPHONE Cr
0
Vr (o) V -'t zc'
STATE LICENSE NUMBER EXPIRATION D TE Y VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
EQ'D POSTED
SEPA REVIEW SIGN AREA 13YERS [3NO Is HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
_j Z�' r) In, EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
x 9 ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
ADDITION COMPLIANCE OR z
COMMERCIAL E
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED CL
REPAIR GRADING FENCE
CYDS ( — x —FT) REMARKS
DEMOLISH TANK OTHER
Ei GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE,,%IISINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYP 0) ONSTRUCT)ON OCCUPANT
GROUP
(n
NUMBER OF I CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA
OCCUPANT
0 STORIES NITS rN'UMBER REQUIRED LOAD
w NUMBER
DESCRIBE WORK TO BE DONE
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D F3
M
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr, Review
W PERMIT APPLICATION: 100 DAYS
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 4APPLICANT, 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
X- EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
M Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
9 DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0
NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION Recording Fee Receipt #
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
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 Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIiIINGTON RELATING TO FOR INSPECTION receipt is acknowledged In space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
0 IALS SPN� URE DATE
��GN41`UR OWNE �NT) DATE S I , G�NED �K/
I- i i __ (42,15)
'4 '11�011 AGI�
'.1 Aim
Nil 771-0220 R DA
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- ORIGINAL - FILE - YELLOW - INSPECTOR
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
1
0
17n
-i T1
M
C:
M
10
0
0 C:
--A K
X M
M z
g) --I
_z
3:
(1)
0 _n
n M
_j >
= 9
M M
0
0
0 M
Cj)
Cn
M C.)
Z
z
U)
z
0
M
I
i
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ......
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
OLi
lWugh-In ...................
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
11
0
M
—i -n
IT!
0
-40
0 C
3: M
M Z
—Z
--I
o -n
n
M M
—C/)
0
0 M
C 0)
Q 0
Z
;U
--I
z
--I
z
0
11
0
M