20040460.pdfDATE RECEIVED
PERMIT EXPIRES L P-4-1744-If
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
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CONSTRUCTION PERMIT APPLICATION JOB C,
EADDRES�S
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OWNER NAME/NAME OF BUSINESS �0 LID NO.
PLAT NAMEISUBDIVISION NO. LOT NO.
2aD LID FEE $
a: MAILING ADDRESS t—TESCP �Apprmed[3
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z epl -_6f) PUBLIC RIGI IT OF WAY PER OFFICIAL STREET MAP f1w Permit Requiled
Street use Pernne Roq'd E3
-0,: Inspection Hariuliod
CITY EXISTING — PROPOSED -------- Sidewalk Required E3
ZIP TELEPHONE.,r??— sq,;- Underground
R REQUIRED DEDICATION� FT 13 1
F--PM0ND5_ VA E SIZE NO. OF FIXTURES PRV REQUIRED
NAME METER SIZE LIN
YES NO 13 z
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I= ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZIP ]TELEPHONE
NAME CBLA
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ADDRESS
DATE ul
FIRE REVIEWED BY cc
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11 CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY R O'D PO . ST:ED
I SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FF.)
NEW RESIDENTIAL PLUMBING if MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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COMPLIANCE OR 2
ADDITION COMMERCIAL z
CHANGE OF USE 'PLANNING REVIEWED BY DATE 5
PARKING i
REMODEL MULTIFAMILY SIGN REO'D I PROW
GRADING FENCE
REPAIR CYDS I X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
[TYPE OF USE,-BIJGINESS OR `)iCTiV`n`Y) EXPLAIN: CQD9 OCCUPANTO
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a OF DWELLING AREAS SPECIAL INSPECTION JAREA LOAD
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D F3
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I I Description FEE Description FEE
State Surcharge
e Plan Check
HEAT SOURCE CXLAZING % L T SI_Olk,� City Surcharge
VESTED DATE
PLAN CHECK NO: Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
Uj DWiTHIN 180 DAYS Engr, Inspection
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTE
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
cn CCESORS Fire Review Plan Chk. Deposit
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SU
W IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
Fire Inspection Receipt #
EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS 'OR DAMAGES OF WHATEVER NATURE, ARISING D113ECTLY OR INDIREC1 LY
L NOT BE
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHAL ndscapelnsp. Total Amt. Due 277 4-iL-
0 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE La
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0 NOR LIMIT IN ANY WAY THE CITYS ABIL11Y TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT." AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S MPTE_N_�JTION INSURANCE AND RCW W.27. C
FIC�IV() SIGNATURV ATE
SIGNATUR& W AGEN DATE SIGNED (425)
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r J,40--?, /'V 771-0220 ASED BY D
ENTI'ON DIU` '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..........................
Pier/Porch .................
Retaining Wall ...........
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0
Slab Insulation ..........
0
PLUMBING: M
Underground ............. --I -n
Rough -In ...................
M
C:
Commercial Final ....... M
0
-40
HEATING: 0 C
M
GasTest .................... M z
Gas Piping ................. C _Z
Equipment .................
Commercial Final ....... 0 -n
-n
EXTERIOR SHEATHING
NAILING .......................... M M
0 C—/)
FRAMING ........................ 0
0 M
C Cn
FIRST FLOOR FRAMING ...
9 CD
Q 0
INSULATION ................... Z r-
71 T
Floor Insulation ......... ;U
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Wall Insulation ...........
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Ceiling Insulation .......
SHEETROCK NAILING
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SPECIAL INSPECTION ... 0
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IT!
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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