20040574.pdfC
DATE RECEIVED
PERMIT EXPIRES 2—
KE PERMIT
ZONE
CITY OF EDMONDS NUMBER _06 ZJZ--
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS
! , PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
N.r I ni \ ( - (! -k
MAILING ADDRESS LID FEE $
TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street Use permit Roq'd [3
EXISTING — PROPOSED Intipection Required 13
CITY ZIP TELEPHONE Sidewalk Floquired
A Underground
REQUIRED DEDICATION— FT Wiring required [3
�Y,f
NAME METER SIZE LINE SIZE FNO OF FIXTURES PRV REQUIRED 13
YES 1:1 NO 13 3
cc
W
z
jT t v/
ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE a
e\ Lu
CITY ZIP 7TELEP�H�k
z,
NAME C
ENGINEERING REVIEWED BY DATE i
ADDFt5iSS
FIRE REVIEWEDJY DATE LU
PRE -INSPECTION REQUIRED a:
CITY ZIP TELEPHONE M
(
VARIANCE OR dUU SHORELINE OR
ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE BY D13 SEWER MU -'Q;q a D At STED
R7 SEPA REVIEW "Na HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO EXEMPj__ ALLOWED PROPOSED ALLOWED PROPOSED
Wj�
0 TER M R TO BE REMOVEq OR
_2aj.�; CA 0 1.0�, o 3.;,, - 0 (:A" — EXP Hn;n Rig iTH AVB iNsTALLOD
_V LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT
NEW RESIDENTIAL PLUMBING I MECH
ALLOWED PROOSIDt MP99U A01RCINEIRD )UMEW SPM'[QNM
z
COMPLIANCE OR -2
ADDITION OMMERCIAL CHANGE OF USE cril n3agol mau 1w 12=10bl z
PARKING tfAdVWMeEffy J 013 4MARD
REMODEL MULTIFAMILY El SIGN REO'D I PRO\VWWWED
GRADING FENCE roR INS' CTION REQUIRE-MENTS
REPAIR CYDS ( X FT) REMARKS
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT El ROCKERY FIRE ALARM
FYPE OF USE, BUSINE&S OR E7X_A(j:
CHECKED BY TYP!pr OCCUPANT
GROUP
M TTt
NUMBER CRITICAL-`
r NUMBER OF ' OCCUPANT
OF VELLING SPECIAL INSPECTION AREA
D% AREAS -1 1 LOAD
STORIES UNITS NUMBER REQUIRED [] YES
/L
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ-D
0
VALUATION
"W $
Description FEE Description FEE
HEAT SOURCE GLAZING % LOT SLOPE % Plan Check State Surcharge
Building Permit city Surcharge
PLAN CHIEC 0 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 Grading
F DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
J SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTERE�T. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPtOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIREC f LY OR INDIREG1 LY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMI1 SHALL NOT BE Landscapelnsp. Total Amt. Due
0 QUIREMENT OF ANY CITY ORDINANCE
_j DEEMED 10 MODIFY. WAIVE OR REDUCE ANY RE
0
NOR LIMIT IN ANY WAY THE CITY's ABILITY TO ENFORCE ANY ORDINANCE PROVISION� Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ '[HIS APPLICATION: THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORIECT,1 I TIIATP1LA,)1, 'E OWNER OR THE DULY AUTHORIZED AGENT OF I tus application is not a pernut until signed by the
THE OWNER I AGR �Po GOP I CITY AND TATE LAWS REGULATING CONSTRUC_
CALL Building 011icial or tus/her Deputy,and Fees are paid, and
TION; AND IN DOING /HE WORK jdJT1 )RIZ , T 1 BY. NO PERSON WILL BE EMPLOYED
FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATI AB OD OF TH S ATE OF WASHINGTON RELATING TO
jp�E I W
WORKMEN' S CE A W 18 27.
kX I I OFFICIAIS SI N T IF L)AT E
'NEDL /') , I
SIGNATURE�;,(_ OR DATE (425)
771-0220 DATE/
ATTENTION EXT 1333 - -------------
ITIS 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. LJBC109/IBC110/IRC110. PINK OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPItz)
z
0
1
0
M
-n
M
C
M
0
0
0 C:
M
M Z
K) --i
C
0)
0 -n
n X
>
M M
0 Co
0 T.-
0 M
Cn
co
Q 0
Z
X
z
Cn
z
0
1
0
M
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
-Pier/Po.rch, .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in ...................
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 ...
PfLL- -7
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
4
0
171
11 -n
j
M
C
M 0
0
0 C
M
M Z
C
0 _T1
n
M M
a v;
0 r-
0 M
C cf)
M 0
Z
r
z
C/)
z
0
171