20040527.pdfI
DATE RECEIVED W705 1
7/7/04 PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
OWNER NAME/NAME OF BUSINESS ADDRESS 830 Alder St
David Perlman PLAT NAMEISUBDIVISION NO LOT NO. LID NO.
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W MAIL ING ADDRESS LID FEE $
z IESCP Approved 0
830 Alder S t PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required E3
Street Uso Permit Ho.0 13
Sidewalk Hoquired 13
CITY Z 11 P TELEPHONE EXISTING - PROPOSED inspection Required 13
8020
REQUIRED DEDICATION- Fl Underground
Edmonds 98020 771-7723 wifing roquiro(( [3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
YES 13 NO z
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OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONIROL/DRAINAGE
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CITY ELEPHONE
hegardless ot whether the water system
NAME CBL 4 wjj�oll 01 CIUS011, expallsion tanks are
Day & Nita MI'Ved on all hot water fanks nnr
EN3N6j1N(;,FE W Y DAT
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ADDRESS e. T601C 19.30.020 (c)
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18614 13th Ave W
FIRE REVIEWED BY DATE W
CITY ZIP ELEPHONE
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Ll Lynnwood 98037 775-6464 VARIANCE OR CU SHORELINE OR ADB,1 I INSPECTION BOND
STATE LICENSE NUMBER EXP)RATION DATE '1__9HECKED REO'D POSTED
I C____ 1 DYES ONO S
DAYNIPF1044CM y SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
W 00434207400900 EXP
1:1 NEW E@ RESIDENTIAL PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
COMPLIANCE OR
ADDITION COMMERCIAL z
F� CHANGE OF USE _�__WED BY __ )ATE z
Tit K111TW - "115'r7.A_,R E.A - PLANN , IlSiG EVIE 5
MULTIFAMILY SIGN R Q'D- I PRCLVJDE I r 7 eetorS QL
REMODEL GRADING 41 1:1 FENCE Typ (! 15 1 1 ventl conn
)0 REPAIR ryns El ( _X _ FT) R mvequlreTu el.buk ji.ig applianess. in—
[] DEMOLISH TANK OTHER tcd spafts; UMC 8L5J a
Ei GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: -tFCONST OCCUPANTL
Fr H o u s cc. CHECKED BY TYPE CTION Cp
GROUP
NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA ST U OCCUPANT
UNITS NUMBER LOAD
0 STORIES I 1 1 REQUIRED [] YES
DESCRIBE WORK TO BE DONE Raplac.=w e.xis-l-.ing REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ-D Ei
G-6-7 Hot Wat-=r Tank w/ New
AREA
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VALUATION
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Description FEE Description FEE
(j Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
HECK NO: VESTED DATE Plumbing ;zt) Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Ir
ul PERMIT APPLICATION: ISODAYS
1L PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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_j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARML-ESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIAt.S, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
x ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT I-Y
49
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERM11 SHALL NOT BE
0 DEEMEDTO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE LandscapeInsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABIHTY TO ENFORCE ANY ORDINANCE PROVISION"
xI Recording Fee Receipt III
,-�Zflcl 'I �/ .
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION I
GIVEN IS CORRECT AND THAT I AM THE OWNER, OR THE DU& AUTHORIZED AGENT OF APPLICATION APPROVAI
THE OWNER. I AGR�E TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- [his application is not a permit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON Wlt-L BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN V�61_ATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTIOR receipt is acknowledged in space provided
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. 0 ICIA( SIGNATURE T
DATE SIGNED
T, 1 7-/
W
SIGNATU I NER OR (425) L
7171 771-0220 RFyFASFD BY 641
ATTEWrfbN 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/Porp.h .................
Ret�iriin'*g'* W�11':....
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
t. ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
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FINAL APPROVAL FOR
OCCUPANCY ..................
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