20040428.pdfI
DATE RECEIVED PERmIT EXPIRES
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USE PERMIT
CITY OF EDMONDS ZONE NUMBER AP
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS f
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
ix MAILING*ADDRESS LID FEE $
TESrP Appio7p�ci[3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Mit Required 0
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0 "w PIOUSO pon,11 Roq*d [3
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CITY inspection Required C3
ZIP TELEPHONE EXISTING — PROPOSED Sidewalk Floquired 0
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REQUIRED DEDICATION— FT
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YESCJ NO 13
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U OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY ZIP TELEPHONE
NAME CBLM
ENGINEERING REVIEWED BY DATE
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0
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FIRE REVIEWED BY DATE
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rz CITY Z14 TELEPHONE iz
0
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I VARIANCE OR CU SHORELINE OR ADI111 INSPECTION BOND
STATE LICENSE NUMBER 1/) EXPIRATION DATFf CHECKED BY REO'D POSTED
SEPA REVIEW SIGN AREA OYES ONO IS HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
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EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
NEW RESIDENTIAL '��P`IMBING I MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT IJR SIDE REAR
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COMPLIANCE OR F
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
REPAIR GRADING FENCE 2- 7, 1 -
CYOS ( X FT) REMARKS 0 WN q $�_gu -7&
r_1 DEMOLISH D TANK F-1 OTHER ri'4V - I - -
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z ElGARAGE RETAINING WALL FIRE SPRINKLER 4— jj IIJ4,141,
CARPORT 0 ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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0 OF DWELLING REAS SPECIAL INSPECTION JAREA OCCUPANT 4
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o STORIES UNITS 06 NUMBER REQUIREDE] YES 1010
DESCRIBE WORK TO BE D*1461dl?j�
REMARKS
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PROGRESS INSPECTIONS PER UBC 1 08/171NAL INSPECTION REQ'D E
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Z
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
- -----------
Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
cc PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN WrERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTlY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL. NOT HE
a DEEMED TO MODIFY WAIVE OR REDUCE ANY REOUIREMEN I OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
3:1 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. Recording Fee Receipt #
1 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 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
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLA z THE LABOR CODE OF THE STATE OF WASIIINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKM;��ATION INSURANCE AND RCW 18�27, OFFICIALS SIGNAYURE DATE
SIG AGEN DATE SIGNED (425) 11_1_�
�13 (Y
771-0220 D-BW/ D/4E
NTION 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- ORIGINAL -FILE YELLOW- INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
z
0
Pier/Porch .................
0
Retaining Wall ........... M
Slab Insulation ..........
i -n
PLUMBING:
M
Underground ............. C 0
M
0
Rough -In ................... —40
0
Commercial Final ...... M
M z
HEATING: C: z
Gas Test ....................
Gas Piping ................. 0
n
Equipment ................. -4
x
Commercial Final ....... M
0 (n
0
EXTERIOR SHEATHING 0 ITI
NAILING .......................... C C0
9 co
M 0,
FRAMING ........................ Z
FIRST FLOOR FRAMING ...
INSULATION ................... x
Floor Insulation ......... z
--I
x
Wall Insulation ...........
z
Ceiling Insulation ....... 0
SHEETROCK NAILING ... 0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................