20040535.pdfI
DATE RECEIVED
ERMIT EXPIRES
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U �� E PERMIT
CITY OF EDMONDS NUMBER,—�,/
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CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS
till 1 S Guf M—IU-11 PLAT NAMEISUDDIVISION NO. LOT NO. LID NO.
LID FEE $
CC MAfLING ADDRESS . . ......... I —
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REQUIRED DEDICATION— FT Wiring rOqUirad
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NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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7 LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FF.)
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REPAIR CYDS ( x FT) REMARKS
OTHER A1_2-Rr4.S.S1ARjg-._ R_ECj1_11=R VAT VECIM4
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(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY ITYPEXPC NSTRUCT N CODE OCCUPANT
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pURSUANT TO UPC 605-2 Description FEE Description FEE
AWATER SERVICE SHUI'OFF Plan Check State Surcharge
911 A I I ]a 12 INS:EAT - F11 ON I
HEAT STRCE j,HE BtqLb
�MATERS M Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
:3 SEPARATE PERMISSION.
Engr. Review
Cc PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT I 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
U)
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIF ISSUANCE OF THIS PERMIT SHALL NOT BE 77�
C3 Landscapelnsp. Total Amt. Due
_j DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 ANCE PROVISION."
NOR LIMIT IN ANY WAY THE CITYS ABIL11-Y TO ENFORCE ANY ORDIN
Recording Fee Receipt it 1)2
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION * THAT THE INFORMATION APP 17CATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC. I his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official 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 COMPENSATION INSURANCE AND RCW 16.27. W
OF7Fr IGNATVRE D6TE
ATE �IGN�D
Sl RE (OWNE GE 1 0 (425)
771-0220 RELEASED BY DA"f E
AtTtNTION EXT 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
091/03 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 ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING*-
G�as lb!ft ....................
Gas Piping .................
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
'Floor Insulation .....
\tyall:insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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