20040561.pdfDATE RECEIVED,/,
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT
70NE
NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB SUITE/APT#
ADD RESS/OFIF &16-w
lsLJAI-�i�l
OWNER NAME/NAME OF BUSINESS
WE 4
P T NAMEISUBDIVISION NO. LOT NO, LID NO.
MAILING ADDRESS
LID FEE $
TESCP APPf0vild 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Prurnit Required 0
street Use Ponn't Roq'd [3
.21ZA;)
CITY ZIP TELEPHONE
EXISTING — PROPOSED inspection Required 0
sidewalk Required E3
-aj
Underground
REQUIRED DEDICATION- Fr Wiring required
NAME
METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO
tu
z
ADDRESS
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
z
E5
z
W
CITY ZIP -71EPHONE
PuRsydmff—Te uple 605.2
AWATER SERVICE SHUTOFF
NAME
SHALL BE INSTALLED ON THE
ICBL#
0 1A E I -At Cj 07 3d--
if IMM 1 � 1!f Fshma-R9 Tf IE wtvIrujo
R"WtPUFN
ENGINEERING
ADDRESS
&5L.3 97-44&16,
FIRE REVIEWED BY DATE
Lu
CITY ZIP TELEPHONE
,4re_41 7LV is 17 2,0 C, - :367--_'5d/'6
TEL
VARIANCE OR CU SHORELINE ORADBIJ INSPECTION ONO
STATE LICENSE NUMBER EXPIRATION DATE CICKED BY
REO'D POSTED
OYES ONO
RtIMEKI X 7 S-IVAJ
S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO.
COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED ROPOSED
'.452 1�3 �:j �-_)
EXP I
,
RESIDENTIAL Z(P=LUMB1Nrj MECH
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LJR SIDE REAR
NEW
ALLOWED PROPOSED
COMPLIANCE OR
ADDITION COMMERCIAL
CHANGE OF USE
z
2
z
PARKING LOT AREA PLANNING REVIEWED BY DATE
15
IL
REMODEL MULTIFAMILY SIGN
REOID v uviuru
n addi
GRADING FENCE
REPAIR CYDS ( FT]i
x
tx required
REMA;
rpressure/relief valve A n a pproved-
OTHER
DEMOLISH TANK
9
listed expansion tank shall he
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY El FIRE ALARM
T_
installed on all hot water tanks.
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
of" 111111
CHECIIES)F%-ITN9V&�,qoN§TRLJCTION CODE OCCUFNNT
is� ri
—.1 11 1 . - - 'n -,"7 GROUT
NUMBER NUMBER OF CRITICAL f
OF DWELLING AREAS
SPECIAL INSPECTIO14 ITRE OCCUPANT
A
LOAD
STORIES UNITS NUMBER
REQUIRED [] YES
DESCRIBE WORK TO BE DONE
0
z
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'D
F3
t 0 cig T& 1�6014
165
X
vALUATidN
$
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
Base Fee
2)
PLAN CHECK NO: VESTED DATE
Plu mbin
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
Cc PERMIT APPLICATION: 180DAYS
W
PERMIT LIMIT1 YEAR - PROVIDED WORK IS STARTED WITHIN 150 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS
Fire Review
Plan Chk. Deposit
Receipt
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
Landscapelnsp.
Total Amt. Due
C3 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
Receipt #
�A`j/
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
x
Recording Fee
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT, AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC CALL Building 011icial or hisitier DLputy: and Fees are paid, and
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 FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIO OF Yt.S SIGNATURE
�JNSURANCE AND RCW 18.27. DATE
SIGtTURE (OWNER OR DATE SIGNED (425)
j! AdE
77
1-0220 RFLEASED BY 1DATE/
ATTENTION Ail EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBCI09/IBC110/IRC110, PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
i
0
M
--I -n
0 M
C
M 0
--i
0
rn
M Z
01
2
x
U)
0 _n
n
M M
0
0
0 M
Cn
M 0
Z
.I�
X
__4
3:
z
U)
z
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footi`rig' 1 ................
V%
Pier/Porch ........ ........
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground
Rough,ln!i ............
er '�l Final ......
C mm cl
EATING;
Gas.Test
s Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
"A LATION ....................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ........... o ......
2w (/a, as tv
z
0
M
--I -n
M
M
0
0 C:
--I K
M M
M Z
n,
-Z
3:
0 -n
-n
i
3:9
M M
0
0
0 M
C: cl)
9 C/)
Q C-)
Z
z
Z
0)
z
0
i
0
M