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DATE RECEIVED
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CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW RESIDENTIAL ID PLUMBING / MECH
ADDITION MERCIAL COMPLIANCE OR
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CHANGE OF USE
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GRADING FENCE
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DEMOLISH TANK OTHER
GARAGE E:i RETAINING WALL FIRE SPRINKLER
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CARPORT ROCKERY FIRE ALARM
(FYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
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DESCRIBE WORK TO BE DONE
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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.
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PERMIT APPLICATION: 100DAYS
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PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORIVATION
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'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, AS.;IGNS AND SUCCESORS
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IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF W1 IATEVER NATURE, ARISING DIRECTLY OR INDinFC I LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY GI IY ORDINANCE
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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
GIVEN IS CORRECT, AND THAT I AM Till OWNER, OR THE DUUY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION AND IN DOING 1HE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN V6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 111.27.
SIGNATU (0 NER �GENT)
DATE SIGNED
PERMIT EXPIRES
PERMIT
NUMBER
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PLAT NAME/SUBDIVISION NO. �tO� NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� F1
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METER SIZE LINE SIZE NO. 0 URES
SUITE/APT#
t—A — 11_.�
LID NO.
LID FEE $
TESCP Approved E3
RW Pof"111 90riulfrid 13
street use Permit Rori'd E3
inspection Required 13
sidewalk Required
Undairground
Wiring required C3
PRV REQUIRED
YES 13 NO 1:1
4EMARKS
:)WNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
:NGINEERING
zIRE REVIEWED BY
VARIANCE OR CU SHORELINE OR ADBAI
DATE
DATE
INSPECTION BOND
REO'D POSTED
CIYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
G XEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
NLLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REQ-D I PROVIDED I
REMARKS
-HECKED BY ITYPE OF CONSTRUCTION C_Qp E OCCUPANT
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SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES I /Mo LOAD
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�ROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
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Description
FEE
Description
Plan Check
State Surcharge
EFEE
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Building Permit
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City Surc harge
Plumbing
Base Fee
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Grading
Engr. Review
Engr. Inspection
Fire Review 514 Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee
CALL
FOR INSPECTION
(42! ,
771-0220
Receipt # 21 L_ I z
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Olficial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
F ICIALS SIGNATURE DAT E
6/
7 , _ 4
Im .,�d /. /
REL
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ATTENftON EXT 1333
IT is
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U W UL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL IN PECTION 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
IN DATE
ORIGINAL - FILE YELLOW - INSPECTO
PINK - OWNER GOLD - ASSESSOR
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Certt'ft'tatt of
DEPARTMENT OF BUILDINGS
PER UNIFORM BUILDING CODE SECTION 109
120 West DayAton A- Building Permit # 2004-0406
Occupancy established by this certificate: -Dwelling Units: **N/A*** No. Stories:— I
B Type of Construction: V-1HR Basement: No
Maximum Occupant Load ***11*** (Per UBC 1002)
Room capacity signs, when required, must remain posted at all times.
Owner of Building Harbor Square Associates LLC Address: 120 West Dayton Street B-6
The Laser MD has been inspected and approved as complying with the requirements of the 1997 Edition
of the Uniform Building Coa—e as adopted by the City for the group and division of occupancy and the use for which the proposed
occupancy is classified.
Issued this 7th day of July 2004
'�WEF BUILDING OFFICIAL
BY:
This certificate shall be posted in a conspicuous public area and shall not be removed, mutilated or obscured and shall be maintained in legible condition at all times. Any change of occupancy or use requires a building permit and a new
Certificate of Occupancy issued by the City of Edmonds Building Official.
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulatior . ..........
PLUMBING:
Underground .............
5) 44
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 ..................
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