20040614.pdfDATE REC
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF DLI-*!,NLSS
LowtKit t�()NDcc)C_ RIA 'Ir
um MAILING ADDRESS
z
0
CITY ZIP TELEPHONE
ti)),�W1,,JRS 0F")'0,kj 4-�6)77b(92,
NAME
-> I t-
1PRU- � W7"\ I TE I A 171� Cc *7 1 ?--,
5F
USE
ZONE /,2)
JOB
ADDRESS
PLAT NAME]SUBBIVISION NO.
I PERMIT EXPIRES
PERMIT
NUMBER
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED --
REQUIRED DEDICATION— FT
MEIER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
/1!1,4
LIE) NO.
LID FEE S
I ESCP Approved
my Permit Required
Street USo Permit Req'd
In5priction Required
Sidewalk Required
Underground
Winng roqu, - I
PAV REQUIRED
YES El NO 11
ADDRESS REMARKS
2+ OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
CITY ZIP TELEPHONE GAS NPE TEST MUST BE
tm(CWDS ac Z69 2-5)27� -- 55-32) OBSERVED BY CITY INSPECTOR
NAME CBL#
AfTIDAVITS SHALL NOT
0—AprVINu ENGINEERING REVI Ew ACCEPTEG DATE
ADDRESS
F?)(�D �1-?Cjv 5T 5`iiQ FIRE REVIEWED BY DATE
CITY ZIP TELE�HONE
0
77 S
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
�j.V\)CA'P.T _C&
PROPERTY TAX ACCOUNT PARCEL NO.
ul bC4C
NEW
RESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
o
FENCE X
(
DEMOLISH
TANK
OT:HER
GARAGE
RETAINING WALL
FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
VARIANCE 08 CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
SHORELINEORADB# I INSPECTION I BOND
REO'D ]NO POSTED
OYES E is
SIGN AREA HEIGHT
LOWED . PROPOSED I ALLOWED . PROPOSED
0
z
z
z
E5
z
W
W
Cc
M
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
FRONT SIDE REAR FRONT UR SIDE REAR
z
E
z
PARKING I LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
FT) I REMARKS
(TYPE OF USE BUSINESS OR ACTIVIM EXPLAIN:
Fr
0
CHECKED BY
jTYPE,0F/, UCTIO
82
CODE
)_Z
OCCUPANT
GROUP
uj NUMBER NUMBER OF CRITICAL
C R
OF DWELLING FAREAS
SPECIAL INSPECTION
AREA
nrr., P4
U
STORIES NUMBER
0 UNITS
REQUIRED
LOAD
DESCRIBE WORK TO BE DONE
0
REMARKS
z
C-,7
PROGRESS INSPECTIONS PER LIBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
� y--e Z/6 r, A I—ztl 5
VALUATION
/ ��Y_
�;p IE� 7z( I's
$
7 V 05 �_Q Zz S
Description
FEE
Description
FEE
Plan Check
State Surcharge
HEAT
tL SOURCE GLAZING % LOT SLOPE %
Building Permit
City Surcharge
PLAN CHECK NO: VESTFD DATE
Plumbing
Base Fee
- c t;
�o4
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
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
W PERMIT APPLICATION: 100 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
uj IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
_j
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
Fire Inspection
Receipt #
ir
4 ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMI1 ISSUANCE OF THIS PERMIT SHALL NOT BE
Landscapelnsp.
Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
X1
Receipt it
—
Recording Fee
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 UWS 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.
F DATE
IURE
SIGtUq Q NER AGE DATE SIGNED
1
(4 25) /,I1ALS,,SIGf
/
%_
771 )220
RELEASED BY U E
ATTENTION
EXT 1333
IT IS UNLAWFULTO USE OR OCCU PYA BUILDI NG OR STRUCTURE UNTI LA FINAL
INS P ECTI ON HAS B E EN MAD E AN D AP P R OVAL 0 R A C ERTI FI CATE OF OCCU-
ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110.
PINK - OWNER GOLD, ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
1
0
M
--I -n
0 M
C
M
0
C-)
0 C
M
M Z
jo --i
0 71
n
M M
0 _Cn
0 17-
0 M
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 .............
Rough -in ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ......................
Floor Insulatio n ..........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
LAyf ID
SPECIAL INSPECTION
,..!SCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0&
400ti
z
0
1
0
M
--I -n
1711
C
M
0
__110
0 C
M
M z
0)
o -n
n
M M
055
0 r-
0 M
C C/)
9 Cn
ITI 0
Z
z
--I
65
z
0
0
M