20040442.pdfDATE RECEIVED( F
PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS ZON NUMBER
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JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS. '7
OWNER NAME/NAME OF BUSINESS
Icy-VIC PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
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W MAILING ADDRESS LID FEE $
z TESGP Approved 13
0 PUBLIC RIGHT OF WAY PER OFFICIAL. STREET MAP Rw Permit Required E3
?� I I Lu'. street use Permit Roq'd [3
CITY ZIP TELEPHONE EXISTING — PROPOSED inspection Required 13
REQUIRED DEDICATION— F1 Sidewalk Required E3
Underground
6A.0"vonck <.s 15 c),?—(0-> 6t 2!15-� -,7, C�o 1 Wiring required C3
NAME METER SIZE LINE SIZ�j NO. OF FIXTURES PRV REQUIRED 0
YES13 NO 121 z
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ADDRESS REMARKS z
L) OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ilP TELEPHONE
NAME CBL#
ENGINEERING REVIEWED BY DATE
ADDRESS
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uoa. FIRE REVIEWED BY DATE W
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CITY ZIP TELEPHONE M
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
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STATE LICENSE NUMBER EXPIRATION DATE CH&CKED 13Y REC'D D
MOA 01 , AAArV111YES P(NO
0 V30 Z.0 0 URI :n SEPA REVIEW SIGj#\REA HEIGHT
PROPERTY TIACCOUNT C I I - COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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EXP 4-
LOT COVERAGE REQUIRED SETBACKS FT) PROPOSED SETBACKS (IT)
1:3 NEW E] RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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ADDITION COMMERCIAL COMPLIANCE OR IC ------- E
CHANGE OF USE z
PARKING LOT AREA IG REAW kY DATE
REMODEL MULTIFAMILY E] SIGN REO'D PROVIDED pg;
GRADING FENCE
REPAIR CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BU!jINFSS OR ACTIVITY) EXPLAIN:
CHECKED BY I TY.PF OF CONS R CTIO COCIE OCCUPANT-
iE GROU4,-"
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W NUMBER NUMBER OF CRITICAL
a OF DWELLING<�� AREAS SPECIAL INSPE6TION AREA OCCUPANT
all UNITS NUM13E LOAD
o STORIES R REQUIRED [] YES
DESCRIBE WORK 10 BE DONE I
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
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Descrip It ion
r\ (A FEE Description FEE
LV Plan Check State Surcharge �7
HEAT SO4RCE GLAZING % LOT SLOPE % Building Permit -:5-7 `7 City Surcharge
816:1e_-14 26�xzf�_�ajfu/_�;_, 41_/�) — 5
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
L// � / Mechanical
THIS PERMIT AUTHORIZES ONLY THE �ORK 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
LU PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) Fire Review Plan Chk. Deposit
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS
Uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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I EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
OR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECHLY
ALL CLAIMS F
X1 FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BF
9 DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY Cl IY ORDINANCE LandscapeInsp. Total Amt. Due zoj�
0 NOR LIMIT IN ANY WAY1 HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fe Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLicArION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENr OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a perinit until signed by the
TION; AND IN DOING THE WORK AUTIIORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building 011icial or hisilier Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIIINGrON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. --- NAIURE DATE
OFFICIALS dtC4
SIGNATU E (OW ER R /,:A�G E DATE GNE (425)
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j 771-0220 �Etr.AS
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IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL /I , ti /I 6'1/�/
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGIN�L - rLI E YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - ;TKER GOLD - ASSESSOR
09iO3 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
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0
Slab insulation .......... I
0
PLUMBING: M
Underground .............
Rough -In ...................
M
C
commercial Final ...... M 0
0
0
HEATING: 0 C
3:
Gas Test .................... M
M z
Gas Piping .................
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Equipment ................. 3:
Commercial Final ....... 0 -n
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EXTERIOR SHEATHING --I
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NAILING .......................... M M
0 —
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FRAMING ........................ 0 r-
0 M
FIRST FLOOR FRAMING ... C= 0)
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INSULATION ................... Q 0
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Floor Insulation ......... X
Wall Insulation ........... M
Ceiling Insulation ....... z
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SHEETROCK NAILING ... Cj)
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SPECIAL INSPECTION 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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