20040597.pdfDATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
Z�/-0-710 - 9,_T?� 2C '73 3
NAME
ADDRESS
CITY
ZIP
NAME jCBL#
ADDRESS
CIT ZIP TE�gPHONE
STATE LICENSE NUMBER EXPIRATION� DATE C
4
PROPERTY TAX ACCOUNT PARCEL NO
NEW
RESIDENTIAL
ED/ MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYOS
FENCE
( X Fr,
E] DEMOLISH
TANK
OTHER
GARAGE
CARPORT
RETAININGWALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
ul NUMBER OF CRITICAL
W NUMBER
OF DWELLING AREAS
UNITS NUMBER
0 STORIES
DESCRIBE WORK TO BE DONE
SOURCE GLAZING % 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 (CURDS, SIDEWALKS. DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMITll YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO 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 DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1HIS PERMI1 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 -
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 AGREE 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 THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATUR� �(OWNEA OR AGENT.V,/ DATE SIGNED
PERMIT EXPIRES
SE PERMIT
ZONE NUMBER
JOB SU91T/ -PT#
ADDRESS
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
LID FEE $
41E�SFP �APPry
(3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
use permit Roq'd
street
inspection ftq�llrrd
EXISIING - PROPOSED
Sidewalk Rectu'red
undergtotind
C3
REQUIRED DEDICATION- FI
Wiring required
METER SIZE
NO. OF FIXTURES
pRV REQUIRED
11*'
Zrc
YES [3 NOA
ul
REMARKS
FOR EROSION CONTROLiDRAINAGE
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OWNER/CONTRACTOR RESPONSIBLE
111
D BY
FIRE REVIEWED BY
lk", :11TU14014IN01111011
SEPA REVIEW
COMPLETE , EXEMPT
EXP PZ—
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE ul
a:
M0WRAPPj#I IINSPECTION BOND
Do POSTED
REO'D
OYES S
SIGN AREA HEIGHT
ALLOWED PROPOSED I ALLO VED I PROPOSIED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT L/RSIDE REAR
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REMARKS
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CODE OCCUPANI
4
GROURN
SPECIAL INSPECTION JAREA OCCUPANTI
REQUIRED [] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REQ'D,
5
d'-t .4 -A _42- . 1�� � A �A�_,_� .9,_ M
VALUATION
$ 110f,
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge ILI
L? 07 City Surcharge
)41"1, Base Fee
CALL
FOR INSPECTION
(425)
771-0220
Plan Chk. Deposit
Receipt #
Total Amt. Due r 11
Receipt #
eip' #
APPLICATION APPROVAL
This application is not a permit until signed by the
i
as
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged if, space provided.
p
FFICIA)-S SIGWURE T
DAT
'1112-77a
A17ENTION MA I I J%30�_T
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
DATE
2 -21
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FINAL PROJECT XPPROVAL FORM
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PLVASHSIGN
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PLEASLSIGN
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SITE ADDRESS -
PERMIT # -7- ADB# DATE INSPECTED
DESCRIPTION OF WORK TO BE INSPECTED '71
-approved plans. Final approval
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denotes that there are no objections from the above signed Department to the release of
PERFORMANCE BONDS and the granting of:
GRANT FINAL PROJECT APPROVAL
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0 Copy of CONDITIONS given to owner/contractor by inspector
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2.
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RE-fNSPECTED OUTSTANDING ISSUES - GRANT FINAL PROJECT APPROVAL
Date Signature
1:ten1p:b1dg:fbrn1s:ocaprv1 3/25/04
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
0
Footing ......................
Wall ..........................
Pier/Porch .................
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
MISCELLANEOUS ....
FINAL APPROVAL FOR
OCCUPANCY ..................
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