20040488.pdfW
DATE RECEIVED PERM
IT EXPIRES
F PERMIT
ZONE
CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMENAME OF BUSINESS ---
Iacy'szs�-) PLAT NAME/SUBDIVISION NO LOT NO LID NO.
MAILING ADDRES!�) LID FEE S
TESCP Approved 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP 13W Pafrinit Required 0
C:) Ve Street Use Prima Roq'd 13
t �j rt EXISTING � PROPOSED inspection Required 0
CITY `kIP TELEPHONE Sidewalk Required [3
1 underground 0
i A I-% REQUIRED DEDICATION— FT
6�moras (�go D'D METER SIZE NO. OF FIXTURES PRV REQUIRED
NAME YES0 NO
ADDRESS REMARKS
OWN E"QbLTp,,%C10FLRESeQNS tBLE FOR FnQjiQU.CQNj9,QWUUA"4GE
Permit from It
CITY __27P TELEPHONE
Industries
NAME CBL
ENGINE, -RING REVIEWED BY DATE
ADDRESS
.101,Mi PL VFIRE REVIEWED By DATE
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CITY ZIP
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TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE
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PROPERTY TAX ACCOUNT PARCEL NC
-7 00 669) W( D
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NEW RESIDENTIAL PLUMBING / MECH
�ICOMPLIANCE
OR
ADDITION COMMERCIAL D CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
g/1REPAIR CYDS X� FT)
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY 13 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN' -
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NUMBER
OF
NUMBERI
DWELLIN(
CRITICAL
AREAS
'01
STORIES
UNITS
NUMBER
'rDESCRIBE
WORK TO 13E DONE
HEAT SOURCE
GLAZING %
PLAN CHEC�_!���
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN JCURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
LU
IL PERMIT LIMIT'. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
@APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTERE�T, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAIURE, ARISING DIRECTLY 0 INDI EC1LY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIBEMEN f OF ANY CITY ORDINANCE
L3 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
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 COMPIY WITH CITY AND STATE LAWS REGULAVING 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 CO M PEN SATIOWy1CVrt0NCE AND RCW 18.27.
R OR A��///,/
DATE SIGNED
VARIANCE OR CU SHORELINE OR ADB INSPECTION BOND
REO'D POSTED
[1YES 0 NO IS
10
SEPA REVIEW SIGN AREA HEIGHT
rVCLIR" hiinwrn ALLOWED PROPOSED
COMPLE
EXP
LOT
ALLOWE
PA
REO'D I PROVIDED
REMARKS
CHECKED BY
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SPECIAL INSPECTION JAREA U��Vr
LOAD
REQUIRED EE
REMARKS
PROGRESS INSPECTIONS PER UBC 1108/113C109 I IRC109 FINAL INSPECTION REO'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
FEE Description FEE
State Surcharge
P.
City Surcharge
Base Fee
CALL
FOR INSPECTION
Cl%
(425)
771-0220
Plan Chk. Deposit
Receipt it
Total Amt. Due
- - -------- I ---------
elpt 0
Rec eipt #
APPLICATION APPROVAL
Hiis application is not a perinit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided
D E
OFFI IALS ISIG URF
/ lKt
REJ EASED BY DATE
ATTENTION CA I I
IT IS UNLAWFULTO USE OR OCCU PYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OFOCCU-
FANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SE-tBkdK§ . ..................... J,
FOUNDATION:
Footing .......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground ..........
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ...........
nic Initials Ware Milton
Thompson, a temporary contract
inspector for the City.
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