20040365.pdfr_
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
6Kr"j_54`;I L�c
MAILING ADDRESS
7;o
CITY
&t M --, " I
NAME I
CITY
NAME
1-�' no
ADDRESS
16 1,9
CITY
ZIP T LEPHONE
4<4 �ko I
I LJ6 ;,S) -1 0,-_1 ri -7
ZIP
e ry
Ajyt.le� Aj
ZIP
TELEPHONE
USE
ZONE
JOB
PERMIT EXPIRES L,
PERMIT
NUMBER
QUITEIAPT#
JAD�DRESS re
S _3
PLAT NAME/SUBDIVISION7 LOT NO� LID NO.
LID FEE $
IESCP Approved Cl
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP FjW Permit Required E3
street Use Permit Hoq'd 0
EXISTING — PROPOSED inspection Required 13
Sidowalk Hequired 0
REQUIRED DEDICATION— FT undergrotind
wiring inquired 13
PRV REQUIRED
METER SIZE LINE SIZE NO. OF FIXTURES
YES 13 NO 13
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
CBL if
IZ 1,5 iz�
ENGINEERING REVIEWED BY
371 11 —, '_ — 1
e N . ' REVIEWED BY
TEI-EPHONE
I" I It
> CA71-1 e.111
5
Aut)
lu ekf.
STATE LICENSE NUMBER EXPIRAT ON DATE
By
�JbK
I
PROPERTY TAX A
,,CCOUNT PARCEL NO.
q L
cc 1
51)0 001 DO I
1:1 NEW
RESIDENTIAL PLUMBING I MECH
1:1 ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
171 REMODEL
MULTIFAMILY
El SIGN
REPAIR
GRADING
13 CYDS
FENLA:
(
X FT)
DEMOLISH
11 TANK
OTHER
GARAGE
RETAINING WALL
1:1
FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
OF
NUMBER OF
DWELLING
CRITICAL
AREAS
STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
re
� F
f-t-4 IVILJ -2
'14 1 --�- IPA:- rii i
0,
igE SOURCE GLAZING % LOT SLOPE %
Af-- I
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
�_j BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
6 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
71 SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICAN1, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD 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 PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION,'
I HEREBY ACKNOWLEDGE THAT I HAVE READ 1111S APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DU& AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION, AND IN DOING T1 IE WORK AUTI IORIZED T1 IEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION i=RANCE AND RCW W,27.
SIGNATUR
_�'#NER 0 'AG N DATEPIGNED'
)t� 4 f
,I -
DATE
DATE
VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
REO'D POSTED
OYES ONO IS
0
Z
M
Lu
z
z
Lu
w
cc
M
SEPA REVIEW
SIGN AREA
ricluf
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
I
L
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT URSIDE REAR
0
z
E
lz
PARKING
LOT AREA
PLANNING REVIEWED BY DATE
IL
1 5
REQ'D I PROVIDED
REMARKS
CHECKED BY ITYPE OF CDASTRUCTION CODE OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED E] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UEIC 1081FINAL INSPECTION REO'D 5
0(i -
I'V 1_11�
ATTENTION
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
04!02 PRESSMAt-iIJI - UU JAII-Ir- 1WI/A I[AU Z) wrll",3
VALUATION
$ <3 C)cx�l
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge
City Surcharge
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signecl by the
CALL Building Olficial or his/her Deputy. and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OFF� DATE
(425) k
771-0220 RELEASED BY DAfE
1 7/ 1
EXT 1333 i : ,, __-
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
GREEN - ACCOUNTING
z
0
A
0
M
-i -n
0 M
C
M 0
0
0
0 C:
M
M Z
3:
0)
0 -n
n ;U
_j >
a: 9
M M
0
0
0 M
C cl)
9 Cn
M C)
Z
z
CD
z
0
I
0
M
a
0
.. M
011
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
Retaining Wall ...........
Slab Insulation ..........
ITI
PLUMBING:
Underground .... I ......... — __4
0) 3:
0
Rough -In ................... C: M
M 0
0
Commercial Final ...... 0
C
HEATING:
3: M
M Z
Gas Test .....................
C
> z
Gas Piping .................
Equipment ................. 0)
0 -n
-n
Commercial Final .......
EXTERIOR SHEATHING M ITI
NAILING .......................... 0
C/)
0
0
FRAMING ........................ M
C 0)
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... 0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0
000