20040381.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
. �)WLIIP ?n
MAILING ADDRESS
49 9 7- 3 -- 2- 2
NAME
ADDRESS
CITY
NAME
ADDRESS
000
;919 41Z
y �r S /"d
ZIP TELEPHONE
04�.72
MM
CITY ZIP
& 7
STATE LICENSE NUMBER
Z, / 7 3
2ROPERTY TAX ACCOUNT PARCEL NO
TELEPHONE
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.77. e. I � 16�
ttt �? ,
TELEPHONE
EXPIRATION DATE 11 4G�IECKED BY
0
NEW
RESIDENTIAL
PLUMBING / MECH
0
ADDITION
'A
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
0
REMODEL
MULTIFAMILY
SIGN
0
REPAIR
GRADING
CYDS
FENCE X. FT,
(
ED
DEMOLISH
TANK
OThER
KC-X..P
GARAGE
RETAINING WALL
FIRE SPRINKLER
z
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINR-S,,OR
ACTIVITY) EXPLAIN: .-h
0L
U)
NUMBER
NUMBER OF
CRITICAL
1:12
OF
DWELLING
I
I
AREAS
I
01
STORIES
UNITS
NUMBER
DESCRI13E WORK TO BE DONE
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4 , &
5�11
[PERMIT EXPIRES
USE PERMIT
ZONE '�tI 05,
NUMBER
JOB C
IC SUITEIAPT#
ADDRESS
PLAT NAME/SUBDIVISION NO. LOT NO LID NO�
'T
LID FEE $
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use Pofnist Roq'd 13
inspection floquirod 13
EXISTING - PROPOSED sidewalk floquirod 13
Undeigfolind
REQUIRED DEDICATION- Fr winno
a
"oqu'�
METER SIZE LINE SIZE NO. OF FIXTURES �TV REQUIRED
I I YES El NO 0
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
ENGINEERING
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
BY
DATE
DATE
SHORELINE OR ADBI I INSPECTION BOND
REO'D POSTED
OYES ONO $
6
SIGN AREA HEIGHT
FALLOWED . PROPOSED ALLOWED , PROPOSED
1.5
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W
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5
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W
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR U)
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PARKING I LOT AREA I PLANNING REVIEWED BY DATE IL
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE 17]Mr___AE OCCUPANT
_jAREA_ GROUP
SPECIAL INSPECTION OCCUPANT
REQUIRED [:] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'D , F3
i
VALUATION
Description
FEE
Description
FEE
Plan Check
I C
State Surcharge
HEAT S OURCE
GLAZING %
I
LOT SLOPE %
Building Permit
City Sur charge
Plumbing
Base Fee
PLAN CHECK NO: VESTED DATE
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
Engr. Review
SEPARATE PERMISSION.
UJI PERMIT APPLICATION: IGODAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
U) APPLICAN1, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
W 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 N
0: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC1 LY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapeinsp.
Total Amt. Due
cl DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Recording Fee
Receipt III
_j
= 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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 This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/tier Deputy: and Fees are paid, and
TION; 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 FOR INSPECTION - receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION -INSURANCE AND RCW 18.27.
0 ICI . SIGNATURE ATE
JATU OW 6V* GEn'- DATE SIq1"D (425)
1//i
C. 771-0220 R - AS .
ATTENTION EXT 1333
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
DA
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 ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -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 .................. ................. i��
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