20040495.pdfI
DATE RECEIVED
CITY OF EDMONDS
USE
ZONE
�z , I ���Alg NOW"r-00
PERMIT L? zi // el"? 4 -1
NUMBER , A/ IV
SUITE/APT#
`7
LOT NO. LID NO.
- I I
Cc MAILING ADDRE LID FEE S
W
z JESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Pornut Required
Street use Permit
R eq"d 13
CITY inspection Required
ZIP PHONE EXISTING — PROPOSED
ITELE Sidewalk Roquited 13
underground
REQUIRED DEDICATION— FT vituing required C3
—1 NO. OF FIXTURES PRV REQUIRED
NAME TER SIZE LINE SIZE 0
K\j LU
2 YES13 NO 13
ILI
I- ADDRESS fl-EMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 43
z
I OkS
CITY MtZ.,TTEILEPHONE
11 Y/,j 'ki &xe) D � % q-1S -S6C) �-O
NAME -7 Ic L
I 17f r ENGINEERING REVIEWED BY DATE
Cc ADDRESS
0
8 S
FIRE REVIEWED BY DATE W
Cc
TELEPH9NE ir
—T
CIT,!) ZIP
-&C;CL - -( VARIANCE OR Cu SHORELINE OR ADBII INSPECTION BOND
STATE LICENSE NUMBER. C ECKED BY 9,0 -
RE POSTED
EIYER 0 i S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE �XEI`41"T ALLOWED PROPOSED ALLOWED PROPQ ED
71 X
tu
-2 EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL 1:1 PLUMBING/MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT UR RE R
t COMPLIANCE OR C DE A
El ADDITION COMMERCIAL 1:1 CHANGE OF USE z
z
PARKING LOT AREA P),MVING REVIEWFD VY DATE -3
REMODEL ULTIFAMILY [:3 SIGN REO'D I PROVIDED ir� /
GRADING FENCE vly/
9M 1176,Vd M44 0 y
REPAIR CYDS
( X FT) REMARKS
DEMOLISH TANK OTHEY t;t,5.
z EDGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT 1:1 ROCKERY FIRE ALARM
r (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
L
Fx CHECKED BY TYPE Of CONSTRUCTION CODE OCCUPANT
IL) - /? ) ) /// z - X/ -7 GROUPX?
U) NUMAER OF -4 Z
M 'I SPECIAL INSPECTIO EA OCCUPANT
uj NUMBE CRITICAL I I -
C3 ' 3 DWELLING AREAS N JAR
OF �<'
0 STOI`12� UNITS NUMBER REQUIRED [-] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS ED
z
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REQ-D Ei
e / Vf%, 11! ic, 1(�-f
Mixt
/0 A,1 of/,C n1v C- VALUATION
Description FEE Description FEE
Plan Check State Surcharge
URCE GLAZING % LOT SLOPE % Building Permit City Surcharge
CK NO: VESTED DATE Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
M SEPARATE PERMISSION. -----
Engr. Review
W PERMIT APPLICATION: IBODAYS — ------
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n Fire Review Plan Chk. Deposit
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt h
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee —FReTcip I t#
/4,)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN I C I 4CT-, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPR5V-OAP�L
THE I A REE TO COMPLY WIT This application is not a permit until signed by the
DO] G THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
I
S C
OW
0 2 H CITY AND STATE LAWS REGULATING CONSTRUC-
TION; �D IN CALL
I/
W
TIC
IN VI LATION 0 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WO�KMEN'S C PENSATION�INSUrNCE AND RCW 18.27.
�- -*I - " , -- - hNE OFFICIALS SIGNATURE D TE
S NATURE ikNE OR 96E DATE_ (425)
r16 771-0220 RE 15A ED BY
1Z
ATTENTION EXT 1333 1�7
. 7 )Iell
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL AllL 1(
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE - YELLOW INSP CTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER - GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINEIS
J013
ADDRESS
601 i
PLAT NAME/SUBDIVISION NO.
V
z
0
A
0
M
4 -n
M
M0
0
--i C-)
0 C:
M
M Z
a -i
C
0 -n
n ;d
>
M M
0 C-1)
0 17-
0 M
U)
Cn
M C-)
Z
z
0)
z
0
i
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
----------
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ........... 0
Slab Insulation .......... --------- 0
M
PLUMBING:
Underground ............. ---------
M
Rough -in ................... C
M
0
Commercial Final ...... __10
0 C
HEATING: M
M Z
Gas Test .................... ---------
Gas Piping ................. --I
0)
Equipment .................
0 -n
Commercial Final ....... n r
__4
EXTERIOR SHEATHING M M
NAILING .......................... 0 6
0 r-
0 M
FRAMING ........................ C CD
?. Cn
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... I
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR L2 4t-
OCCUPANCY ..................