20040539.pdf�D`ATEREC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
9WN�R NAME/NAME OF BUSINESS
Cr
W MAILING ADDRESS
z
3� � ( ", ( c
0
CITY ZIP TELEPHONE
NAME
L)
CITY
NAME
tL,A-�O ( vj('
M ADDRESS
0
CC,,
CITY
00 C
ZIP
TELEPHONE
, - I
elLf .-11:5 1/t/
TELEPHONE
PERMIT EXPIRI ES —Z4L11-1
UIS E
ZONE
PERMIT
NUMBER,
JOB
ADDRESS
SUITEIAPT#
PLAT NAME/SUBDIVISION
NO. LOT NO,
LID NO,
LID FEE $
PUBLIC RIGHT OF
WAY PER OFFICIAL STREET MAP
TLSCP Apritooed
FjW Poinut Required
EXISTING -
PROPOSED
Street Use pon,it Req'd
inspection Hequired
Sido*alk Harttived
HEOUIRED DEDICATION-
FT
underground
Wiring required
REQUIRED
YES 0 NO 0
REMARKS
OWNER/CONIRACIOH RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
A 'ZiLl %A I L IZLI U. I I I Ll U11 - U I I I 11111 it p Ij 11"ll,
CBL Y
unhaated spaces. UMC 815.1.7
ENGINEER.J�G REVIEWED BY D�
STATE LICENSE NUMBER EXPIRATION DATE
PCKED B
q
PW
PROPERTY TAX ACCOUNT PARCEL NO.
NEW RESIDENTIAL
PLUMBING / MECH
ADDITION COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
GRADING
REPAIR CYDS
FENCE
x Fr)
DEMOLISH TANK
El OTHER
GARAGE RETAINING WALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF US,g, PUS P5 SS OR ACTIVITY) EXPLAIN:
NUMW/-
0 Fg;� I
NUMBER OF
DWELLING
CRITICAL
AREAS
ST ItV
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
L(j o
\ I C N V,
6- 1 fai- tV S fn� 6
k-" C) C) u, 1�4 t. I
i�#4__ 0 01 ll-, 1141 ri,
L
HEAT —SOURCE
GLAZING %
I LOT SLOPE %
PLAN CHECK NO: I 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: 180 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTERESf, 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 INDIRFCTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS 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 THE OWNER, OR THE DULY AUTHORIZED AGENI 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 COMPENSATION INSURANCE AND RCW IB.27.
SIGNATURE (OWN OR AGENT) QATE SIGNED
7' . I/ , 1 7A7-/
FIRE REVIEWED BY
DATE
VARIANCE OR CU
HOR15LINE OR AD111
INSPECTION
I BOND
REO'D
I
POSTED
OYES ONO
is
SEPA REVIEW
1EXP
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
,
,
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJA SIDE REAR
z
z
Iz
PARKING
I
LOT AREA
PLANNING REVIEWED BY DATE
I
1 5
REO'D I PROVIDED
(L
REMARKS
CHECKED BY
ROUP
SPECIAL INSPECT& AREA OCCUPANT
REQUIRED E:] YES LOAD
REMARKS
z
PROGRESS INSPECTLQVI%PA�WJBC=PIFJNALU"E�CIJON REO'D F3
VALUATION
5 -� L "
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE Description FEE
State Surcharge
City Surcharge
Base Fee 3.15"7
Plan Chk. Deposit
........ .
Receipt 0
Total Amt. Due
Receipt it
APPLICATION �AFPHOVAL
I his application is not a peffnit until signed by die,
CALL Building 011icial or his/hor Deputy: and Fees art, paid, and
FOR INSPECTION receipt is acknowledged in space Provided.
CIALS.SIqNATURE DATE
(425) ''t
771-0220 REIiASED 11Y DATE
ATTENTION L E)ff 1333
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
09103 PRESS HARD -YOU ARE MAKING 4 COPIES
Fire Review
Fire Inspection
Landscapelnsp
Recording Fee
ORIGINAL -FILE YELLOiV.INSPEC70R
PINK -OWNER GOLD-ASSESSOF1
P,
z
0
1
F5
M
-4 -n
0 M
C
M 0
0
C)
0 C
--i C
X M
M Z
g) --I
C:
0 -n
n x
>
M M
0
0
0 M
C Cn
K cf)
M 0
Z
;U
-i
X
z
W
z
0
1
0
M
K11z UKLJ Ur IVIZsrr- I lul'40
INSPECTOR DATE APPROVED
-SETBACKS'-:, ................... .
FdU04TION:
Footing .; ....................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
Commercial Final ......
HEATING:
GasTest ........................
Gas Piping ................. a4_
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION .....................
Flocir'ln'suldtion .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
0
171
—11 -n
M
C
M
0
0
0
M
M Z
C
0 _n
_n
M M
0
0 171
C Cn
M 0
Z
;U
z
z
0
0
M