20040423.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUS)
PERMIT EXPIRES e�
USE PERMIT
ZOW Q I?
NUMBER
,JOB E/APT #
ADDRESS
PLAT NAME/SUBDIVISION NO LOT NO LID NO,
LIC MAILING ADDRESS
U LID FEE $
z TESCP Approved' E3
0 PUBLIC RIGhT OF WAY PER OFFICIAL STREET MAP
(0 AW Permit Raquitrid El
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so Permit Raq'd 13
CT; ZIP -EPHONE EXISTING - PROPOSED inspection Required 13
Sidowalk Requiled 13
REQUIRED DEDICATION- FT Underground
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wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PFIV REQUIRED
U YES NO
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ADDR SS REMARKS z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
LU
=CITY
ZIP TELEPHONE
NAME CBLts
ENGINEERING REVIEWED BY DATE
cc ADDRESS
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Cr FIRE REVIEWED BY DATE
CITY ZIP _[TELEPHONE
0
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VARIANCE OR CU SHORELINE OR ADBN INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY I REO'D POSTED
I V-X"v 11 OYES ErNO is
SEPA REVIEW SIGN AREA HEIGH
PROPERTY TAX ACCOUNT PARCEL N COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
LU
01
n EXP 19F51
NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr:) PROPOSED SETBACKS (Fr.)
P 1:1 ALLOWED PROPOSED FRONT SIDE REAR FRONT LJRSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR V 14S 14) z
CHANGE OF USE 327, 23,:4 10 I(> Az, 5 17 2
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PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY E:1 SIGN REO'D I PROVIDED fj
GRADING FENCE -3 .25A4141i .5/1 ;?—k+
El REPAIR CYDS X Fr) REMARKS ej
E] DEMOLISH TANK ER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY El FIRE ALARM
(TYPE OF USE, BUS)N�SS OR ACTIVITY) EXPLAIN:
Er CHECKED BY ITYPE OF q�AT�CTION Q00E - OCCUPANT 1171
U v Ac k_� GROUP
NUMBER OF CALO
LU NUMBER '17 140
SP ECIAL if
OUI E
CRITI F
OF DWELLING AREAS SPECIAL INSPECTION OCCUPANT
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to STORIES UNI NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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VALUATION
Description FEE Description FEE
Plan Check 6717 State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
OL
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT covEns WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
:3
1,_ SEPARATE PERMISSION.
M Engr. Review
III PERMIT APPLICATION: 180 DAYS
ILI PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Engr. Inspection
U) 'APPLICANT, ON BEHALF OF HIS OR HEII SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
U)
LU IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir Fire Inspection Receipt # Ir I
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIYORINDIRFCHY
FROM THE ISSUANCE OF [HIS PERMIT ISSUANCE OF IHIS PERMIT SHALL NOT HE
Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 1
NOR LIMIT IN ANYWAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION Recording Fee Receipt # LZ
APPLICATION APPROVAL
GIVEN IS CORRECT ' AND THAT I AM THE OWNER, OR THE DUTY AUTHORIZED AGENT OF
THEOWNER. I AGREE TO COMPLY Willi CITY AND STATE LAWS FIEGULAI ING CONSIRUC I hai application is not a riefinit until signed by the
TION, AND IN DOING T1 IE WORK AU n IORIZED T1 IEREBY, NO PERSON WILL BE EMPLOYED CALL Rudding 011icial or hs/hoi Deputy. and Fos are Paid, and
IN VIOLATION OF THE LABOR COD� OF THp STATE OF WASHINGTON RELATING TO FOR INSPECTION recuilit isacknowledged in space provided
WORKMEN'S COYLI- NSA] JON INSLJ/FiANCE RCW 18 27
- OFFICIAIS SIGNAIURF DAT
SIGNATU111761:YWN�FP�R,�GE ED
DATE SIG (425)
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A`ft N EXT 1333 1 Z4
IT IS L TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
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A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OHIGINAL FILE YE I LOv�V INSF CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK OWNER GOI D - AS3ESSOH
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
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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 ......... Q
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The illithIls Warc Milt,,,,
Thompsoll, " le"'POI-111-Y contract
inspectol- fol. tile city.
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