20040607.pdfDATE RECEIVED
PERMIT EXPIRES L
USE PERMIT
CITY OF EDMONDS /ONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEiNAME OF BUSINESS
PLAT NAME/SUBDIVISION NO, LOT NO LID NO.
LID FEE $
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MAILING ADDRE I
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW p,,,,t Rriq.arid 13
3. Roq*d [3
Street Use Pe'm
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CITY ZIP TELEPHON5 EXISTING � PROPOSED S,dowjlk Required
undergiotind
llr4o"D �51+ REQUIRED DEDICATION— FT required (3
LIN METER SIZE NO OF FIXTURES PRV REQUIRED
NAME
YES 0 NO 1:3
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CITY ZIP TELEPHONE oil fliel-hurnilip, appliances P4,19"1119
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NAME CBL;*
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r7:r DATE
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STATE LICENSE NUMBER EXPIRATION DATE isted PaffMfiold RE D OSTED
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SE SIGN AREA
PROPERTY TAX ACCOUNT PARCEL NO. COMPILE MI6W 1 ALLOWED PROPOSED ALLOWED PROPOSED
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_j LOT COVERAGE REQUIRED SETBACKS (F-r) PROPOSED SETBACKS (FT.)
RESIDENTI ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE z
NEW AL 14K PLUMBING / MECH REAR (3
COMPLIANCE OR F
ADDITION 13 COMMERCIAL El CHANGE OF USE CA-4Z 1311bC TE z
- aw Y DATE 5
PARKINY' r EbMR�� 11 BY IL
El REMODEL 0 MULTIFAMILY SIGN REQ'D D BY ITY INSPECTOR
GRADING FENCE
REPAIR 11 CYDS ( X FT) REMARKS—AITIUAVI 10
DEMOLISH E] TANK Ei OTHER BE ACCEP I ED
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: T OCCUPANT
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W NUMBER NUMBER OF C RITICAL AREA OCCUPANT
a OF DWELLING AREAS SPECIAL INSPECTION LOAD
M UNITS UMBER REQUIRED
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DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D F3
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VALUATION
$
iption FEE Description FEE
Lo 1:70 p 17
Plan Check State Surcharge
17 A 0 61-IC7
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing IV3 _t .52 0
1 Mechanical J)
THIS FERMI AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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
CL PERMIT LIMIT.* I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review Plan Chk. Deposit
U) 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
(1)
!I 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 Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
x Recording Fee Receipt # 3(/�
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
AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC.
CALL
1 his application is not a permit until signed by the
THE OWNER. I
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
ON RELATING TO
FOR INSPECTION
Building official or his/her Deputy: and Fees are paid, and
receipt is acknowl4ped in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIIIINGT
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27,
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(425)
OFFI 'IA IGNATURE TE
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771-0220
ELI BY DATE
�6 EXT 1333
ATTENTION
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
04,02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL -FILE YELLOW- INSPECTOR
PINK OWNER GOLD -ASSESSOR
GREEN ACCOUNTING
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INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final
HEATING:
GasTest ......... ...........
Gas Piping ................. Z, 9
/De,
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 ..................
Tile Initials MT are Miltol,
'rilompson, a tertiporary contract
inspioctor ror tile City.
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