20040526.pdfI
FDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
MAILING ADDRESS
?R522--2-
CITY ZIW guz 'T LEP14ONE
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NAME
NAME
Dyog LIv
ADDRESS
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CITY
0
STATE LICENSE NUMBER
ZIP I TELEPHONE
ZIP I TELEPHONE
PROPERTY TAX ACCOUNT PARCEL NO.
75 00
0
NEW
RESIDENTIAL
1:1
ADDITION
COMMERCIAL
1:1
REMODEL
MULTIFAMILY
13
REPAIR
GRADING CYDS
�2
DEMOLISH
TANK
EGARAGE
]
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN:_
NUMBER NUMBER OF
OF DWELLING
0 STORIES UNITS
I DESCRIBE WORK TO BE DONE
I
CBL $1
1 1300
PLUM13ING I MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
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al?k /-f � /)//( 6 ( (v � fA
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HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: YESITED
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.
UJI PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST. AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTIY OR INDIRECILY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL Nor BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE Cl IY'S 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 T14E 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
,,�ENSATION INSURANCE AND RCW 18 27.
SIGN , A I Tjr =OWNEAGENT) DATE SIG�tl)
V'J �1�
PERMIT EXPIRES
USE RMIT �4;7
ZONE
MBER
JOB SUITE/APT#
ADDRESS
32Z 2 13,�
PLAT NAMEISUBDIVISION NO. LOT NO. LID NU
LID FEE $
IESC Ap Proved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP BW Permit Bad ... ed
Street Use permit Hari'd (3
inspection atiquired Q
EXISTING - PROPOSED-� Sidewalk Ho,fillred (3
Undotground
REQUIRED DEDICATION- FT Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13
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REMARKS
1-11AIP-rorrIONTRACTOR RESPONSIBLE FOR EROSION COf�ROL/DRA�INAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
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I a
VARIANCE OR CU SHORELINE OR ADB# I INSPECTION BOND
REO'D POSTED
DYES NO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWEE)e PROPOSE;�
91.5 -? 41/ y
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EXP 7j
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKAS(FT.)
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P FERONT UR;I§
ALLOWED POSED FRONT.,e SIDE REAR I LJR?IDE AR
7 f
3 7 16f 5
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PARKING LOT AREA P ING E Y DATE .1
FL
RE PROVIDED 110. ZI—A
REMARKS
CHECKED BY
SPECIAL INSPECTION JAREA
REQUIRED [:] YES lz,-,�-55
OCCUPANT
GROUP
OCCUPANT
LOAD
REMARKS a
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION LA I 1;jjJ
FEE
Description
FEE
State Surcharge
City Surcharge
Base Fee
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 CO
Plan Clik. Deposit
Receipt N
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Hirilding Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE DATE
7--
R1!11EASFD-BY "I
ORIGINAL - FILE YELLOW - INS�ECTC
S PINK - OWNEH GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..................... -------
FOUNDATION:
Footing ......................
Wall.......................... ------------ - -
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Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ....................
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 ..................
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