20040404.pdfDATE RECEIVED
PERMIT EXPIRES
USr PERMIT
ZONE
CITY OF EDMONDS NUMBER
JOB su
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS I ol I 5--T
:f)A 11.101 tA IoPol,'A-ZA PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
M MAILING ADDRESS I
W LID FEE $
z TESCIR Approved
PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP RW Permit Requited Q
ISO 6 -r 5 v/ Street use Permit Roq'd 0
CITY ZIP 7TELEPHONE EXISTING — PROPOSED Inspection Required [3
Sidewalk Roquired C3
REQUIRED DEDICATION— FT underground
E3
2- Wiring required
N _'70. OF FIXTU RES PRV REQUIRED
METER SIZE LINE SIZE
YES13 NO 1:1 z
00010 .01/ RE
W
z
t: ADDRESS REMARKS z
x OWNER/CON1RACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE a
U z
< j W
-5'2--- -7
TY ZIP TELEPHONE l5i- -'s 1-1gii's, V V) 7M -ki 64 wom-f-I
NAME CBLO
.t' 0 ENGINEERING REVIEWED BY DATE
r
ADDRESS
0
15 1 -
4 A , FIRE REVIEWED BY DATE UJI
!Z 1�1 I T ZIP TELEPHONE x
0 U.
I VARIANCE OR CU HORELINE OR ADIIN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
- I SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
PROP?76�"�r, NT COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED I PROPOSED
C3
W :57�
EXP
NEW RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
$..,REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
1:1 REPAIR rYDq E] ( — X —FT) REMARKS
1:3 DEMOLISH El TANK OTHER
z 1:1GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
r (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYPE OF CONST ICTION COQE OCCUPANT
L) GROUP
U) q2-
w NUMBE NUMBER OF CRITICAL
DWELLIN AREAS SPECIAL INSI
0 S UNITS N LOAD
OF G PECTION AREA OCCUPANT
STORIE UMBER REQUIRED [] YES
DESCRIBE WOAK TO BE DONE
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D 2i
)0
VALUATION
, —1 '400
Description FEE Description FEE
Plan Check State Surcharge C)
HEAT SQURCE GLAZING 01G LOT SLOPE % Building Permit City Surcharge
N L
PLAN CrEll Plumbing Base Fee
I VESTED DATE
0� - I 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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
M
Lu PERMIT APPLICATION: 180 DAYS
9L PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANT. 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
EDMONDS, WASHING1 ON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
Ix ALI. CLAIMS FOR DAMAGES OF WHA1 EVER NATURE, ARISING DIRECTLY OR INDIREc'rLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OFTHIS PERMI1 SHALL. NOT BE
01 Landscapelnsp. Tota lt� 7,
i DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE I Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM T14E OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the
TIQt4r,NND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Olficial or his/her Deputy: and Fees are paid, and
IN'VIq(ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowlodged in Sp,1C0 provided.
WO�KMEN'S COMPENSATION INSURANCE AND RCW 18.27. ICI IC DATE/
---- 3IGNAJORE
I k IC Lj�
61 N , R7(OWVNtR AGEN (425)
DATE SIGNED
771-0220/11� Ftf_tA's BY D fE
ATTENTION EXT 1333,,
2
IT IS UNLAWFUL TO USE OR OCCUPY A 13UILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - I�SPECTIO�R
CATE OF OCCUPANCY HAS BEEN GRANTED.. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
M
--I -n
0 M
C
M0
0
--1 0
0 C:
M
M Z
JC) --I
C
0 -n
n
M M
0 _Cn
0 r-
0 M
C Cn
9 Cn
M 0
Z
;U
z
z
0
i
0
M
�71
ILI%
i rl
ZIP
to
([0
WROVED BY ENGINEERING
�e
Date* tO 2�#
nh
-t TWo WPM
DIU + Ila
t! ) -
4r
-LAC
Le
RECElve
APR 2 2 P.Prlo,
PERMIT
e_�l �e2
gm�
c) c
COPY
0
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
GasTest ....................
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 ..................
0
z0ov
z
0
1
0
M
--I -n
M
C
M
0
-40
0 C:
X M
M z
C
0 -ri
n
MITI
0
0
0 M
C()
co
Q 0
Z
;U
--I
z
W
z
0
0
M