20040557.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
"71 �h t) I ��t
LING ADDRESS
I Co rof�aot'(-) Aa 6e _j
CITY ZIP LEPHONE
NAME
ADDRESS
"6
NAME
ADDRESS
ZIP I TELEPHONE
CBL #
,/(,q
i
I PERMIT EXPIRES
IIISE
PERMIT
ZONE
NUMBER
JOB
ADDRESS
SUITE/APT#
LZI
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
HW Porten Required
Street Use Formit Floq'd
EXISTING — PROPOSED
Inspection Required
sidewalk Required
REQUIRED DEDICATION—
FT
Underground
Wiring required
METER SIZE LINE SIZE NO. OF FIXTURES
PRV REQUIRED
YES 13 NO 0
HEMARKS
OWNEWCONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE
�_y I �j %_�7 1 (__ ,a \__x/ --- �Ae FIRE
CI;*' ZIP TELEPHONE
VAf
SAfE LICENSE NUMBER EXPIRATION DATE By
11 — r_i4 A 7 /)/� I(
/"� � . A Z art j
ING REVIEWED BY DAT E
Type B oi- 1, vent connectarq i-rvst
oahzel-bull-ningapplin rice, paSginrTE
through iinficafed Spaces. IAIC 8
SEPA REVIEW
COMPLETE EXEMPT
PROPERTY TAX ACCOUNT PARCEL NO.
EXP ,
NEW
RESIDENTIAL
PLUMBING if MECH
LOT
ALLOI
;OJ"G
F1 ADDITION
E] COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
1(2�11 EMODEL
MULTIFAMILY
SIGN
PAF
REO'D
�ING
R""i
r
E] REPAIR
GRADING
CYDS
FENCE
( x FO
REMARKS
DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
CHECKED BY =TYPeA
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: C-)
n NUMBER
NUMBER OF
CRITICAL
0 OF
DWELLING
AREAS
M STORIES
0
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: 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 FINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES ro 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 DIREcrLy on INDIRECTLY
FROM THE ISSUANCE OF THIS PERMM ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, 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 1HE INFORMATION
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-
TION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN Vi6LATION OF THE LABPR,.
QODE OF THE STATE OF WASHINGTON RELATING to
T
WORKMEN'S COWENSATlgp-r*U tkNCE AND RCW 18.27.
DATE SIGNED
REO'D POSTED
OYES ONO is
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
LOT Aaj PLANNING REVIEWED BY DA11l
SPECIAL INSPECTION JAREA
REQUIRED C] YES
GROUP
OCCUPANT
LOAD
CS (Fr.)
REAR
0
Z
cc
W
z
z
a
z
2
z
5
a
REMARKS z
PROGRESS INSPECTIONS PER USC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D I �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-022%j
"it
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building official or hisitier Deputy: and Fees are paid, and
receipt Is acknowledged in space provided.
OFFICIALS IGNALURE ATE
�k
RELEASED BY I DATE/
ATTENTION' F.A 1
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR ACERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
A
0
M
:q --fi
o ITI
C
M 0
0
__10
0 C
M
M z
_z
X
0)
o n
n
-1
M M
0
0
0 M
C: cl)
9 Cf)
M 0
Z
z
Cn
z
0
1
0
M
i
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ............
Slab Insulation ..........
PLUMBING:
.,-.IJnder%�und,..,.j ...........
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
71
z
0
A
0
M
--I -n
0 M
C
M 0
0
0 C
M
ITI Z
—Z
--I
x
Cn
o -n
af
M M
0 —Cn
0 r-
ITI
0)
0)
Q 0
Z
z
--I
:C
Cn
z
0
i
0
M
W