20040376.pdfI
DATE RECEIVED
USE
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CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
MAILING ADDRESS
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CITY ZIP ITELEPHONE
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ADDRESS
CITY ZIP ITELEPHONE
NAME
WA-,;�HE'6:�Q4
ADDRESS
-2
PERMIT EXPIRES
PERMIT
NUMBERc2
JOB
ADDRESS oczq�
122 f , ( -
PLAT NAME/SUBDIVISION NO. I LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
Q1 IITF:/APT#
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LID NO.
LID FEE $
TESCP A-Pproved
13
RW porMit Required
13
Street Use Permit Floq'd
[3
inspection Required
Sidewalk Required
E3
Underground
REQUIRED DEDICATION— F1 Wiring required 13
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
I I YES 0 NO 11
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EF12SIO 0 OL/DRAINAGE
E-1 M
CBIL #
ENGINEERING REVIEWED BVDI: tl DATE
tj FIRE REVIEWED BY DATE
CITY ZIP fj TEL PHONE
STATE LICENSE NUMBER EXPRATION DATE Cl- CK BY
0.— C' -7
A)A -- i (=��
PROPERTY TAX ACCOUNT PARCEL NO.
0 (_3 j��57, 00 T-60
NEW
_VRESIDENTIAL
tXPLUMBING
/ MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
El
REMODEL
MULTIFAMILY
SIGN
REPAIR
o
FENCE
( X Fn
GRADING
CYDS
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL
FIRE SPRINKLER
FIRE ALARM
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
— r�%
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
'�Z UNITS ER
STORIES , I NUMB IQ *
DESCRIBE WORK TO BE DONE T�
6
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G
461 -) -
CHECK NO.,
GLAZING %
LOT SLOPE %
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.
PERMIT APPLICATION: ISO DAYS
ul
IL PERMIT LIMI'P. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT. ON BEHALF OF HIS Oil HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
M
Lu IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND
Ir ALL CLAIMS FOR DAMAGES OF WI IAT EVER NATURE, ARISING DIRECTLYOR INDIRECTLY
x
x FROM THE ISSUANCE OF THIS PERMI F. ISSUANCE OF I HIS PERMIT SHALL NOT HE
C3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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01 NOR LIMI r IN ANY WAY THE CIFYS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION."
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-
1ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATU (OWNE O)Q�T D�� IGNE I D
4� njjV_jj 1�2 1
.1 A / t el k
JLLPIV 11 BOND
VAR NbftttWff'� Tw POSTED
ONO S
State �It
7E SIGN AREA H IGHT
' zlQVAW. PROPOSED
COMPLETE EXOXI�T_� ��EVPRQRQ"Q ED�
EXP'
LOT COVERAGE REQUIRED SETBACKS PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REA FRONT LIR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY
REO'D I PROVIDED I
REMARKS
CHECKED BY ITYPK9F
SPECIAL INSPECTION JAREA
REQUIRED [] YES I
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
0
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W
z
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15
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REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D FS
D
M
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
ff FEE Description I FEE
L__ State Surcharge7
.�10
FOR INSPECTION
(425) 0/
771-0220'
1= Vr -lei el a
City Surcharge
Base Fee
Plan Chk. Deposit
EE[R E #
eceipt
I
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building official or hisitier Deputy: and Fees are paid, and
receipt is acknowledged ill space provided.
��CIJLEVS_113NATURE /I DAT
ATTE - NTION L-/
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
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY
ORIGINAL -FILE YELLOW- INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .....
.................
Wall ...................
Pier/Porch .................
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
Z
Underground ............. M
0
171
Rough -in ................... 0
__10
0 C
Commercial Final ......
M
HEATING: ITI z
6 — _�S C _Z
Gas Test .................... >
Gas Piping ................. OA 3:
0 -n
Equipment ................. ri
Commercial Final ....... 3:9
M M
EXTERIOR SHEATHING
0
NAILING ..........................
0 M
C: Cn
FRAMING ........................ w
Q 0
Z
FIRST FLOOR FRAMING ...
'NSULAT'ONr,.* ..................
3:
Floor Insul.ation ..:� ...... >
z
Wall Insulation ...........
f cn
Ceiling Insulation .......
z
0
SHEETROCK NAILING ... --I
0
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................