20040613.pdfI
DATE RECEIVED _7
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USE 7 PERMIT
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CITY OF EDMONDS r-, /, NUMBER 2VU
CONSTRUCTION PERMIT APPLICATION JOB I SUITE/APT#
ADDRESS e7
OWNER NAME/NAME OF— 10(16. CA��OC LAt\jrl
BUSINESS
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a: MAILING ADDRESS PLAT NAME/SUBDIVISION NO LOT NO LID NO.
W LID FEE $
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30 G1 JESCP Approved 0
0 A A C PU13LIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit I'loquarid 0
Street use Parina Roq'd 0
ITY Cj t": 71P TEJILEPHONE EXISTING — PROPOSED Inspection HilqUiled E3
Sidn*alk Required
REQUIRED DEDICATION— FT underground
.10 Wiring required E3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
,,0_7
YES 0 NO 13 z
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x REMARKS z
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROWDRAINAGE z
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CITY ZIP TELEPHONE
NAME CBL# 0
'SCATTLE, kir-06m fk�.�(wf ENGINEERING REVIEWED BY DATE
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STATE LICENSE NUMBER EXPIF!f.T�[N VARIANCE OR Cu SHORELINE OR ADBI INSPECTION BOND
ATE CHECK?q BY REO'D POSTED
MTOYES E]NO S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED
I PROPOSED
006�1-8470c,) 0c) 1 1 EXP
RESIDENTIAL PLUMBING / M LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
NEW 'P41 0 ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE z
ADDITION COMMERCIAL 1:1 CHANGE OF USE 2
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PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY [_1 SIGN REO'D PROVIDED CL
GRADING FENCE I I
REPAIR CYDS ( x FI) REMARKS
DEMOLISH TANK OTHER
ECH
OR
GARAGE o RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE QE-W64_,, BUSINESS OR ACTIVITY) EXPLAIN: CHE ___ 7PE 07F QTS R7UGTION OCCUPANT
777 GROUP
W NUMBER NUMBER OF CRITICAL
o OF DWELLIN AREAS ON JAR
M G SPECIAL INSPECTI EA OCCUPANT
to STORIE UNITS NUMBER LOAD
DESCRIBE WORK TO BE DONE Of_� REQUIRED [] YES
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HEAT SOURCE I GLAZING % I 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
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
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SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
CL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
:E 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 SHAIA NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY 1 HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
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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 COMPANSATION INSURANCE AND RCW 18,27.
SIGNATURE (OWN IPPPRIJA T DATE SIGNED
,Q�
—710
REMARKS a
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 RNALINSPECTION REQ'D I z
VALUATION
$ 17
Description FEE
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
Description FEE
StateSurcharge
City Surcharge
Base Fee
Plan Chk. Deposit 6111vtl
Receipt # 17 57S
Total Amt. Due -ci a
Receipt #
APPLICATION APPROVAL
This application is not a porinit until signed by the
Building Official or his/her Deputy: and Foes are paid, and
receipt is acknowledged in space provided,
FIqALS SIGNA RE I T E
ATTENTION EXT 1333
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCIIO. 4L
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY DAtF
ORIC YELLOW
PINK - OWNER - GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
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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