20040538.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
0'05-WL4 r-6 W�-rV C. K
MAILING ADDRESS
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CITY ZIP T. ELEPHONE
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NAME
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CITY ZIP [TELEPHONE
NAME CBL 01
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ADDRESS
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STATE LICENSE NUMBER EXPIRAT19N DATE I CyfCKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
42�25-Lq(
1:1 NEW jg RESIDENTIAL PLUMBING MECH
ADDITION *S COMMERCIAL COMPLIANCE OR
CHANGE OF USE
1:1 REMODEL El MULTIFAMILY F� SIGN
REPAIR GRADING CYDS FENCE X Fr,
OTHER
DEMOLISH TANK
EiGARAGE Ei RETAINING WALL E:] FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSIWS OR ACTIVITY) EXPLAIN:
in
Lul NUMBER NUMBER OF CRITICAL
0a OF DWELLING AREAS
0 STORIES c5:4 UNITS z I NUMBER
DESCRIBE WORK TO BE DONE
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HEAT SOURCE GLAZING %
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ECK NO:
LOT SLOPE %
VESTED DATE
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.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITY`S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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_PERMIT EXPIRES IiL�
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USE PERMIT
ZONE 21
N U M B E R
JOB L SUITE/APT#
ADDRESS 2-
PLAT NAME/SUBDIVISION NO. I LOT NO. to NO.
LID FEE $
irzSCP AppfOvOd
RW potent Floquited
Speol Use Permit Roq'd
inspection Required
SIdew,11k Rilquired
underground
Wiring required
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 1:3
REMARKS
OWNER/CONIRACIOR RESPONSIBLE FOR EROSION CONTROLiDRAINAGE
unheal
-RING REVI
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADB# INSPECTION PBOND
REO'D OSTED
DYES ONO Is
SIGN ARE HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT URSIDE REAR
PARKING LOT AREA I PLANNING REVIEWED BY DATE A
REO'D I PROVIDED
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REMARKS
CHECKED BY I TYPE
OCCUPANTe
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REO'D 3
5
IDE T�:RT MUST Bt 10
I UACI [- y iNsFECT --I
I OBSERVED By C11 L�. OT
VALUATION
Description
FEE
Descr iption
FEE
Plan Check
State Surcharge
Building Permit
/_/X)
City SUrcharge
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
77j�-
Recording Fee
Receipt #
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I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAI
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- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED rifEREBY, NO PERSON WILL BE EMPLOYED Building Olficial or his/tier Deputy: and Foes 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 18.27.
OFFi Ls SIG A URE DAT
SIGNADJRE (OWNE R\ GfN I DATE SI cu (42.5)
DAT
RELEASED BY
771-0220
E)ff 1333
A17ENTION 6)
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 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
FoolliNg* .....................
Wall .............
Pier/Porch ......... .......
Retaining Wall ...........
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Slab Insulation ..........
0
PLUMBING:
M
Underground .............
Rough -in ...................
--I
7-
M
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Commercial Final ......
M 0
0
HEATING:
0
0 C:
Gas Test
M
....................
M Z
ID
Gas Piping .................
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Equipment .................
C/)
Commercial Final .......
0
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EXTERIOR SHEATHING
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NAILING ..........................
M M
FRAMING A ................
0
FIRST FLOOR,F6ANING ...
0 M
Cn
C/)
'TION ..........
iNSULA
Q 0
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.16pr* Insulation .........
;0
Wall Insulation ...........
Ceiling Insulation .......
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SHEETROCK NAILING ...
SPECIAL INSPECTION
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0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile Initials MT are Milton
Thompson, a temporary contract
illspector for the City.