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20040603.pdfOZ10 0/0 SOL, CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAMEMAME OF BUSINESS MAILING ADDRESS CITY ZIP TELEPHONE NAME _rAca-1 Ilf M , Lu I— ADDRESS cc I COL_UJACA4 CITY ZIP I TELEPHONE 31fAlrulL NA ME CBL N ADDRESS Efs 0-(.P T LEPHONE C __T^�S_ (Q-70 �, z T,�IP55 4!e STATE LICENSE NUMBER EXPIUATION DATE TMN0C-)(—*)52—A'7 40.5�' � PROPERTY TAX ACCOUNT PARCEL NO. NEW RESIDENTIAL PLUMBING / MECH ADDITION COMMERCIAL COMPLIANCE OR CHANGE OF USE REMODEL MULTIFAMILY SIGN REPAIR GRADING CYOS FENCE ( X FT) DEMOLISH TANK OTHER GARAGE RETAINING WALL Ei FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: i /-Ifl S�A� yl=::� NUMBER OF � NUMBER OF DWELLING I CRITICAL AREAS I STORIES UNITS NUMBER DESCRIBE WORK TO BE DONE ot_� SOURCE " I GLAZING % I LOT SLOPE % PLA 15HEC�NNO'_/ 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 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 DIRECTLY OR INDIRECTLY FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE DEEMED TO MODIFri WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION." PERMIT EXPIRES USE PERMIT ZONE NUMBER JOB ADDRES PLAT NAME/SUBDIVISION NO. LOT NO. PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP EXIS1ING — PROPOSED REQUIRED DEDICATION— FT METER SIZE LINE SIZE NO. OF FIXTURES SUITE/APT# j LID NO LID FEE $ TESCP APP10ii0d RW Permit ROquif0d Street Use Permit Rriq'd Inspection Required Sidewilik Required Underground Witing required PRV REQUIRED YES E3 NO I� REMARKS OWNERICON­IRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE ENGINEERING REVIEWED BY FIRE REVIEWED BY VARIANCE OR CU T—SHORELINE OR ADBO SEPA REVIEW COMPLETE EXEMPT EXP I LOT COVERAGE ALLOWED PROPOSED PARKING REO'D I PROVIDED REMARKS CHECKED BY SPECIAL INSPIECTIC REQUIRED [] YES DATE DATE INSPECTION BOND REO ' D POSTED OYES ONO IS — SIGN AREA I ALLOW HEIGHT ALLOWED . PROPOSED ED , PROPOSED REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT) FRONT SIDE REAR I FRONT L/R SIDE REAR LOT AREA I PLANNING REVIEWED BY DATE OF CONSTRUCTION CQDE OCCUPANT ', — I _tz-- 14-1-7 GROUP t:� JAREA OCCUPANT LOAD REMARKS PROGRESS INSPECTIONS PER UBC 1108/FINAL INSPECTION REQ'D FEE Description State Surcharge /3-/11 -/1 _� City Surcharge FEE Plan Chk. Deposit Receipt # Total Amt. Due Receipt N C 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 THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit until signed by the TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided. WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27. OFFkCIA SIGNATUK- - DAT E SIrTURE (OWNER 0) NA DATE SIGNED (425) z Z(,12 A_ RELEAS 'DATE 03 771-0220 AWENTION Off 1333 IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGII�Al_ - Fll_�-/- YELLC4V - INSPEC"TOR CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK:OWNER - GOLD -ASSESSOR 04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING W z z a z W VALUATION $ 4113 (f 3 Description Plan Check Building Permit Plumbing Mechanical Grading Engr. Review Engr. Inspection Fire Review Fire Inspection Landscapelnsp. Recording Fee 0 z 2 z z 0 1 0 M =i =n- Cl) M C M 0 0 --i (-) 0 C: M ITI Z 10-1 -Z x W o -n n M M 0 0 0 rn C C/) 9 cn M 0 Z z W z 0 M RECORD OF INSPECTIONS INSPECTOR DATE APPROVED SETBACKS ..................... FOUNDATION: Footing...................... Wall .......................... Pier/Porch ................. Retaining Wall ........... Slab Insulation .......... PLUMBING: Underground ............. D4 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 .................. z 0 i 0 M