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20040450.pdfDATE RECEIVEDPin Jim No� USE. CITY OF EDMONDS ZONE CONSTRUCTION PERMIT APPLICATION JOB ADDRESS OWNER �JA/NAME OF BUSINESS ( r /✓ J/ f PLAT NAME/SUBDIVISION NO. W MAILING ADDR r> _ FADDRESScca ADDRESS 1 .) Of LICENSE NUMBER ZIP TELEPHONE Y? 4- v ZIP I TELEPHONE i/I i ` � i�%ZIP /// TELEPHONE r11x ACCOUNT PARCEL NO. ❑ NEW ESIDENTIAL ❑ ADDITION ❑ COMMERCIAL ❑ REMODEL MULTIFAMILY ❑ REPAIR ❑ GRADING CYDS ❑ DEMOLISH ❑ TANK ❑GARAGE RETAINING WALL CARPORT ❑ ROCKERY (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN NUMBER NUMBER 0 OF DWELLING STORIEV NITS DESCRIBE WORK TO BE DONE red en fuel -bur. nin CBL4 r % UMBING / MECH COMPLIANCE OR ❑ CHANGE OF USE ❑ SIGN ❑FENCE ( X FT) ❑ OTHER ❑FIRE SPRINKLER FIRE ALARM I PERMIT EXPIRES iZ PERMIT ' NUMBERi - )x//x/--///`/Y PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXISTING PROPOSED REQUIRED DEDICATION FT METER SIZE I LINE SIZE I NO. OF FIXTURES SU17E1APTb l LID NO. LID FEE S TESCP Approved ❑ RW Permit Required ❑ Street Use Permit Req'd ❑ Inspection Required ❑ Sidewalk Required ❑ Undmground Wrong required ❑ PRV REQUIRED YES ❑ NO ❑ REMARKS OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE AWATER SERVICE SHUTOFF ENGINEERING REZfUfU :o L1G kllu" A` "URTt LINE AS IT TNIT_RS THE BUILDING FIRE REVIEWED BY DATE 0 2 W. z z a z ur VARIANCE OR CU SHORELINE OR ADBH INSPECTION REO'D OYES ONO I BOND POSTED S SEPA REVIEW SIGN AREA HEIGHT COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED EXP LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.) ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR z Z z PARKING LOT AREA PLANNING REVIEWED BY DATE g REO'D I PROVIDED REMARKS CHECKED BY A PRESSURE REGULAIDR VALVE (PRV) CRITICAL AREAS FFREQUIRED CTION ARE NUMBER YES PECTIONSPER VALUATION Description FEE • Plan Check LOT SL PE % Building Permit nnTF Plumbing Mechanical THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO -- F BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE ~ SEPARATE PERMISSION. Engr. Review W PERMIT APPLICATION: 1B0 DAYS a PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr, Inspection SEE BACK OF PINK PERMIT FOR MORE INFORMATION N •APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review W IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF i EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY = FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscape Insp. DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE = NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. • Recording Fee I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION GIVEN 13 CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.,al CALL TION; AND IN DOING THE WORK AUTHORIZED THEITEBY, NO PERSON WILL BE EMPLOYED IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON •-RELATING TO, FOR INSPECTION WORKMEN'S COMPENSATIOJ( SU CE AND RCW 18.27. ,SIGNATURE (OWNE R AGENT) �. DATE SIGNED (425) 771 w0220 81S.a-.7 GROUP OCCUPANT LOAD /IRC109 FINAL INSPECTION REO'D UST BE Description FEE State Surcharge City Surcharge Base Fee Plan Chk. Deposit Receipt # Total Amt. Due Receipt 0 APPLICATION APPROVAL T his application is not a permit until signed by the Building Official or his/tier Deputy: and Fees are paid, and receipt is acknowledged in space provided. Kyfi S SIGNATURE / DATE i ni ecn 1IV TE ATTENTION EAT 1333 IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU- PANCY HAS BEEN GRANTED. UBC 109 / IBC110 / IRC110. 09/03 PRESS HARD =YOU ARE MAKING 4 COPIES ORIGINAL - FILE YELLOW - INSPECTOR PINK -OWNER GOLD -ASSESSOR I Z O 0 M oM m� OC _ M mZ p� DZ �Cn OM n mrn_ O� n r C C0 9Cn n �D 2 D Z 2 Z 0 C) M RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: at to It �'Vr• '�'' Ftloting ��.. Wall Pier/Porch lot Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. Rough -In Commercial Final ...... HEATING: Gas Test Gas Piping ................. Equipment Commercial Final ....... EXTERIOR SHEATHING NAILING .......................... FRAMING ........................ FIRST FLOOR FRAIVU{JG•.. • ; INSULATION ;I Floor' I nswIation. •.,,A.... %'•Watl'Frrsulafion ........... Ceiling Insulation ....... ;00 SHEETROCK NAILING ... ` SPECIAL INSPECTION ... to 0 1- • 0 -` MISCELLANEOUS .......... FINAL APPROVAL FOR OCCUPANCY .................. `V ` *co® t O n M 'n -1 vM m 0 O ,� Oc = s mZ A� Dt r -I