20040354.pdfI
FDATE RECEIVED
PERMIT EXPIRES P
us� PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/A4#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER N ME/NAME OF BUSINESS �:Vo 2
LOT NO. LID NO.
PLAT NAMEISUBDIVISION NO.
C? C�f �,
M MAILING ADDRESS
W
z
3,
0 5-1q
5 A ve
CITY ZIP TELEPHONE
4F am? o /) c r A J ��2_j-,) � 7/
NAME
ADDRESS
C ITY
NAME -. ,
I "I ; �//—
ADDRE—SS
A,
CITY
STATE LICENSE NUMBER
ZIP I TELEPHONE
PHONE
f . �1
CBL #
DATE I CHECKED BY
PROPERTY TAX ACCOUNT PARCEL NO.
b
hl"NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
191--100MMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
F-1 REPAIR
GRADING
CYOS
FENCE
( — X FT)
E] DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS Of� ACTIVITY) EXPLAIN:
D2\ t,
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
/ 1 9—J-11
V _�V� ), qk�"
HEAT SOURCE I GLAZING % I LOT SLOPE %
LID FEE $
TESCP ApPrOvild 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required E3
Street Use Permit Raq'd 13
EXISTING __ PROPOSED
insp�ction Required 0
Sidewalk Required 13
REQUIRED DEDICATION— Fr
Underground
wiring required 0
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 0
uJ
z
CTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
5
z
LU
PLAN CHECK NO: (,Y/—/& / 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.
L
U
L
j
PERMIT APPLICATION: 180DAYS
LU
PERMIT LIMIT1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
uj IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
01 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
ERING REVIEWED BY DATE
FIRE REVIEWED BY DATE ul
a:
I M
SHOREL11 E_
VARIANCE OR Cu N OR ADB# INSPECTION BOND
RE 'D POSTED
OYES 0 S
SEPA REVIEW SIGN AREA '0 HEIGHT
COMPLETE , EKT ALLOWED , PROPOSED ALLOWED PROPOSED
0
EXP qs0 6
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
---------- z
PARKING LOT AREA I P N NG REW DATE
REO'D I PROVIDED I _�� tiA48 IV .5 / 71(1 q
REMARKS
eyim
1� (i
//— %rc
JP,
V--tLz�x
CHECKEDBY I TYPE PF-P9I4j5TRUCTIClN E OCCUPANT
GROUP
A"
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
1PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D_, �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
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 LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN-SfQUPENS�TJON INSURANCE AND RCW 18.27. 1
DATE P71GED
0
FEE Description FEE
to State Surcharge
e- City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
n
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt it
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
I t)ATE
r C SIGN h
11 A AT E
lk T 4,)
rE I f 1;�^ I 1 %30
Is U�MT�TO USE OR OCCUPY A BUILDINZOR STRUCTURE UNTIL L/A
i� � L OR A CERTIFI-
A FINAL INSPECTION HAS BEEN MADE AND APPROVA
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
1IGINAL -
LE Y a - lNSP(ATC
GOLD.
PINK - OW fER GOLO-ASSESSOR
z
0
i
0
ITI
--I -n
V5
M
ITI
0
--I (-)
0 C:
--I K
X M
ITI Z
01
_z
x
W
0 _n
n
__I
x
M M
0 6
0 r-
0 M
C (n
9 Cn
M 0
Z
z
--I
X
cif)
z
0
171
1�
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
Pier/Porch ................. 0
0
Retaining Wall ....
M
Slab Insulation ..........
PLUMBING:
--I
M
Underground .............
C
M 0
0
Rough -In ...................
0 0
Commercial Final ......
M
M Z
HEATING: --I
Gas Test .................... >
Gas Piping .................
0 -n
-n
Equipment .................
Commercial Final ....... M M
Cn
EXTERIOR SHEATHING 0
0
NAILING .......................... M
C: CD
9 Cn
FRAMING ........................
M 0
Z
FIRST FLOOR FRAMING... 7`1
INSULATION ...................
>
Floor Insulation .........
z
Wall Insulation ...........
Cn
Ceiling Insulation ....... z
0
SHEETROCK NAILING ...
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR MIS C.,
OCCUPANCY ..................
o0q_