20040555.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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CITY ZIP I F1 EPHONE
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NAME
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I CITY
NAME NN JAVNL—�,
H [ CH A t�,L,
ADDRESS
ZIP ITELEPHONE
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CITY ZIP
V--DMDK)0'5 110201
TELEPHONE
U�, '7
STATE LICENSE
NUMBER
EXPIRATION DATE
CHECKED BY
W A K I
F—L,*- qcjc?Fk)
(e
PROPERTY TAX
ACCOUNT PARCEL NO.
610 4
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NEW
RESIDENTIAL
PLUM13ING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GR FENCE
CYDS X—FT)
DEMOLISH TA7K
OTHER
EGARAGE
]
RETAINING WALL
E]
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN -
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER ley) -.5
DESCRIBE WORK TO BE DONE
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HEAT )CCE GL7 % LOT SLOPE %
PLAN CHECK
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERM COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cr
Lu PERMIT APPLICATION: 180 DAYS
EL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESOHS
Cn I
�j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND IfOtD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NAIUHE, ARISING DIRECIFLYOR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
011 NOR LIMIT IN ANY WAY THE CITY'S 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 AGENT OF
THE OWNER. I AGRiE 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 T14E STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW IB 27.
S1,PNATURV-SOV41P�-OR AGENT) I DATE SIGNED
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PERMIT EXPIRES
USE / I
ZONE PERMIT
NUMBE9�
JOB
ADDRESS
SUITEJAPT#
'D
PLAT NAME/SUBDIVISION NO.
LOT NO,
LID NO,
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TIESCP Approved
fiw Pennit Required
C3
C3
stfoot use flonnit SO(I'd
E3
EXISTING — PROPOSED
inspection floquirtid
Q
Sidewalk Required
13
REQUIRED DEDICATION. FT
Und0(glOUnd
witing inquired
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO
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REMARKS
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OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
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VARIANCE OR CU SHORELINE OR ADB# I INSPECTION I BOND
REO'D. POSTED
OYES )QNO IS ��
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , E7PT ALLOWED PROPOSED ALLOWEk PH OSED
EXP 1 13-3
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE.. HEAR FRONT iJR SIDE REAR
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At IEWfD JBY
PARK LOT ARrEPjl� WNING REV DATE
REO'D I 'F�RGQVIDED
to C
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REMARKS
CHECKED BY I TYPE OF
SPECIAL INSPECTION JAREA
REQUIRED [] YES
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL I
VALUATION
$ /A "?
Description
OCCUPANT
GROUP U
OCCUPANT
LOAD
0
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TION REQ'D a
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i�6771 Ei
FEE Description FEE
71 State Surcharge 6-22
City Surcharge
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Base Fee _4�ex�_
Plan Chk. Deposit I !�;?'
Receipt # -2
Total Amt. Due
V Receipt #
APPLICATION APPROVAL
[his application is not a permit until signed by the
Building 011icial of hisitter Deputy: and Fees are paid, and
receipt is acknowILdged in space provided.
OFFICIAL S SIGNA1 URE DATE
Z/
REI I-MFD B� I
/ I I DATE
ATTENTION EXT 1333 V
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- OHIGINAL - � FILE YELI� OW
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER COLD - ASSESSOR
09'03 PRESS HARD -YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
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MREED & ASSOCIA TES PS 6/11/04
Civil & Structural Engineering I I
8311 212th St. SW, Edmonds, WA 98026
CI Office (425) 778-2793 Fax (425) 775-2073
ELL
Memo �ow � Z
TO: 172,* 4e &Wer;x o s,
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From: Reed & Associates, PS
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall .......................
Pier/Porch .................
Retaining Wall ...........
z
0
Slab Insulation .......... I
PLUMBING, M
Underground .............
Rough -In ... ............ W
M
C
Commercial Final ...... M
0
-40
0
HEATING: C
--I
3: M
Gas Test .................... M Z
Gas Piping ................. C
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Equipment ................. r-
W
Commercial Final ....... -n
EXTERIOR SHEATHING
NAILING .......................... M M
0—
00
FRAMING ........................ 0 r-
0 171
FIRST FLOOR FRAMING ... C CD
INSULATION ................... 0
Z
Floor Insulation .........
Wall Insulation ...........
z
Ceiling Insulation .......
SHEETROCK NAILING ... C/)
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SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR 144' 6
OCCUPANCY ..................
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