20040451.pdfI
DATE RECEIVED
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PERMITEXR11RES
CITY OF EDMONDS
7-
USE PERMIT
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NUMBER- Z:ZL
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CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADDRESS 19317 83rd Pl W wmww�
OWNER NAME/NAME OF BUSINESS
LID NO.
PLAT NAMEISUBDIVISION NO.
LOT NO.
Darren Zimmerman
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LID FEE $
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MAILING ADDRESS -
TESCP Apolmed
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19317 83rd Pl W
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Rw permit Required
Street use Ponnit Roq'd
0
EXISTING - PROPOSED
inspection Aoqjjijod
Sidewalk Requited
CITY ZIP
Edmonds 98026
ITELEPHONE
425-775-5013
REQUIRED DEDICATION� FT
unclergrotind
Winng required
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
NAME
YES 0 NO
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REMARKS
OWNERICONTRAClOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
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ADDRESS
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PURSUANT To jiX 6&5.2
CITY ZIP ]TELEPHONE
4 WAMR SERVICE siluTOFF
SHAI -T�E
NAME CBL4
13E iNS ON
LINE AS IT ENrrER�q
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FaSt Water Heater
ENGINEERING REN ED BY
0
ADDRESS
DATE
15
12601 132 Ave NE
41
FIRE REVIEWED BY
CITY ZIP TELEPHONE
Kirkland 98034 425-814-3124 VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE FIE
I CHECKED BY O'D POSTED
FASTWHCO52DF 2 - 16 - 0 5 Vfml,�V 1[1YE! ONO S
PROPERTY TAX ACCOUNT PARCEL NO.
00572500001500
11
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
El
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESSj0FlI ACTIVITY) EXPLAIN:
Lu NUMBER NUMBER 0
a )iA&
I ) I DWELLING
0 S
DESCRIBE WOR� TO BE DONE
Remove/replace g
loset
91
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
FT)
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
as water heater in
40.000 btus
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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.
PERMIT APPLICATION: 180DAYS
tu
91. PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
in
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
0 DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
-i
2 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
SEPA REVIEW SIGN AREA HEIGHI
r
COMPLETE ,EXEMPT ALLOWED PROPOSED ALLOWED ROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBIACKS (FT)
T SI D R T U SI
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
PARKING LOT AREA PLANNING REVIEWED BY DATE
REO'D I PROVIDED 3URSUANT TO ECDC 19.30.020
REMARKS 770 WSSUIW, REGULAMIR VALVE (MV)
CHECKED BY TYPE - "CONSTRUCTI�Qlhl COPE OCCUPANT
:Y
SPECIAL INSPECTION AREA OCCUPANT
3 ] LOAD
REQUIRED [] YES
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REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPEC
M
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
T
Fire Inspection_
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION [:A 1 11000
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION 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
I 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIO"SURANCE AND RCW IB.27.
E SIGNED
W DAT
SIGNATURE (OWNEPRF114604T�)
Plan Chk. Deposit
Receipt P
Total Amt. Due
Receipt #
APPLICATION APPR6VAL
This application is riot a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
C
OF, I ALS SIGNATURE DATE
SED BY ATE
ORIGINAL - FILE YELLOW INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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R ORD OF INSPECTIONS
EC
DATE APPROVED
INSPECTOR
....................
SETBACKS.%!
FOUNYAiION'
FootJlng.%-� ............
Wall..........................
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Pier/Porch .................
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Retaining Wall ...........
0
Slab Insulation .......... 0
M
PLUMBING:
Underground .............
0 M
Rough -In ................... C
M
0
Commercial Final ......
0 C
—4
HEATING: M
M Z
s Tdst
...................
C
Gas Oipi'n'g ................. > z
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Equipment .................
0 -n
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commercial Final .......
3:9
EXTERIOR SHEATHING M M
NAILING ............................ 0 —
0
0
M
............ C C0
FIRSTrFLO6R FAAWNG ... M 0
Z
INSULAT'I'ON ....................
Floor Insulation .........
3:
>
Wall Insulation ........... z
nsulation ....... 3:
Ceiling I
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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