20040552.pdfI
PERMIT EXPIRES
DATE Rk2n, 0114-A -1 1 417 C=
USE PERMIT
CITY OF EDMONDS ZONE NUMBER,ztvJ -nzti�2.
JOB ITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS OF.) - 9
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OWNER NAME/NAME OF 13USINESS
PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
Lu MAILING ADDRESS LID FEE S
z IESCIJ Approved 13
3. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
0 Street Use Perena Roq-d [3
CITY ZIP LEPHONE EXISTING — PROPOSED Inspection Required 13
Sidewalk Required E3
�U&h REQUIRED DEDICATION— FT Underground
"NQf `�C�; 1�1-0NAO Maq Wiring required 13
NAME METER SIZE LI�E NO. OF FIXTURES PRV REQUIRED
YES 13 NO 13 z
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ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
0 z
CITY ZIP TELEPHONE
NA�� CBLk
-Q� V t I ENGINEERING REVIEWED BY DATE
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ADDRESS
0
FIRE REVIEWED BY DATE uj
CITY ZIP TELEPHONE M
0 1
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
H D B
STATE LICENSE NUMBER EXPIRATION DATE C roo I I REO'D POSTED
Or" OYES ONO S
Nz- —j P 4- SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
'Y
W ( Y W /�5 -) z
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EXP
PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FF.)
RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
El NEW COMPLIANCE OR z
ADDITION COMMERCIAL 2
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED IL
REPAIR GRADING FENCE
CYDS ( x FT) REMARKS
DEMOLISH TANK Ei OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z 1:1 CARPORT E] ROCKERY E] FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVI
CPS& OCCUPANT
CHECKED BY TYP,
Mr GRID
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U) 4UMBER OF CRITICAL
OF )WELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
—7,[JNITS NUMBER REQUIRED LOAD
w NUMBER
0 STORIES
DkSC VQRK TO BE DONE
,RIBE 3L
REMARKS
%J PROGRESS INSPECTIONS PER UBC 108 IBC109/ IRC109 FINAL INSPECTION REO'D
M
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
HECK 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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION. Engr. Review
cc PERMIT APPLICATION: 180DAYS
Uj
EL PERMIT LIMIT., I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
UP) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPtOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
M
.X ALL. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC FLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CIIYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM TIIE OWNER, OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL I his application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees arc paid. and
IN VIOLATION OF THE LABQ OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
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OMPENSAT/Ld� S RA CE AND RCW 113 27.
R \R G DATE S NED OFFICIA1 SIGNArU5E DATE
ONATU (0 (425)
D d,
A 771-0220.
)Lj A U_ �,I -,EsT DATE/
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW- INSPECTOR
PANCY HAS BEEN GRANTEE). UB 10!9/IBC110/lRC110. PINK -OWNER GOLD -ASSESSOR
4 - -YOU ARE MAKING 4 COPIES
09/03 CVe I.J Ile LLC PRESS HARD
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
Retaining Wall ........... 0
0
Slab Insulation .......... M
PLUMBING:
—1 -n
Underground ............. Cn x
0 M
Rough -In ................... -7- /Sr C
PH
0
Commercial Final ...... 0
0 c::
HEATING: M
M z
Gas Test ....................
Gas Piping .................
Equipment .................
0 -n
-n
Commercial Final .......
EXTERIOR SHEATHING M M
NAILING ..........................
0 r—
rn
FRAMING ........................ a)
FIRST FLOOR FRAMING ... rn 0
Z
__4
INSULATION ...................
Floor Insulation ......... .
>
Wall Insulation ........... I z
Ceiling Insulation .......
SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ... 0
ITI
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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