20040617.pdf9
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
QWNER NAME/NAME OF BUSINESS
We 3 ' Ae
MAILING ADDAEdS
. � ") C/ r, / e) I I or
CITY ZIP TELE.Of-IONE
Y,?/ 3 7 ;�)`f:
ADDRESS
CITY
ZIP I TELEPHONE
2�1, I Oq
USE
ZONE
JOB
ADDRESS
PLAT NAME/SUBDIVISION NO
PERMIT EXPIRES
I =100M
PERMIT -7
NUMBER
ab i
r =074 0
PUBLIC RIGHT OF WAY PER OFFICIAL STREEI MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE I LINE SIZE I NO� OF FIX
sL)iTE/APT#
01\j
I,ID NO
LID FEE S
If SCP NIPIOV60
13
HW P01M.1 HOfitmod
0
st"'t u's, por"111 H.N d
13
10,14.Lijon 14"(10611"1
E3
E3
TURFS
PRV REQUIRED
YES 0 NO El
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONIROLJDRAINAGE
A� � - CBL 4 / q. I-
ss rVA14 r..- I ri-7 1 1 $ ,I L__1 ENGINEERING REVIEWED BY
14 . 1-1)
10OZ71- x /
CITY ZIP
Z_
STATE LICENSE NUMBER
0 it kp—bl�� Zld)_61W
PROPERTY TAX ACCOUNT PARCEL NO.
&�,_ Z5�WL19 1�z — 0
TELEPHONE
41 7C13
EXPIRATION DATE
e,V1,41 (�
NEW
RESIDENTIAL
ADDITION
XCOMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESSOq �CTIWTM EXPVIN:
go
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN ,
ENCE
X� FT)
OTHER
FIRE SPF31NKLER
FIRE ALARM
NUMBER NU M B E R 0 F CRITICAL
OF DWELLING AREAS
STORIES t UNITS NUMBER gq
DESCRIBE WORK TO BE DONE
HEAT SOURCE
GLAZING %
LOT SLOPE %
PLAN CHECK NO: �7-2 VESTED DATE
o14- 1�e? 7 1
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
cc PERMIT APPLICATION: 180 DAYS
U1
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 SUCCESUH5
Cn
!j IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS 'THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
a:
4 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
a ORDINANCE
DEEMED TO MODIFY� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
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 1HE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATI�"61J.RANCE AND RCW 16.27.
SIGNAT RE (OWNER NT) DATE SIGNED
FIRE REVIEWED BY
VARIANCE OR CU I
SEPA REVIEW
COMPLETE EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
DAT E
DATE
ORELINE OR ADB# INSPECTION E30ND
REOD POSTED
40 /jP I [:IYES �1&0 IS
SIGN AREA IIEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (IT) PROPOSED SETBACKS (Ff.)
FRONT SIDE REAR I FRONT UR SIDE HEAR
0
Z
Ir
Lu
z
Lu
Ir
rL
z
1 PARKING I LOT AREA PLANNING REVIEWED BY DATF 0.
REO'D I PROVIDED -17,1 -OU4-
1 IV— — /3 , 1h,
REMARKS
CHECKED BY ITYPE OF 9',ONSTRUCTION OCCUPANT
T QVEZL) GROUP
L4
SPECIAL INSPECTION AREA U(;UUVAN I
REQUIRED M YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D
A 13 AA to
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt N
Total Amt. Due 15—
Recei pt N iu 6-?Z7
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Foes are paid. and
receipt is acknowledged in space provided
OFYCDA
'AN%PRE DAT E
h / . --I/ .
ATTENTION 6/ 'A 1 1 J'jj
ITIS UNLAWFULTO USE OROCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ED BK PAIL
FILE -
GOLD -ASSESSOR
z
0
1
0
M
=11E
W
0 M
C
M 0
0
0
0 C:
--I K
X M
M z
C) --I
C: —Z
X
(n
o -n
n
--I
af
M M
0
0
0 M
C (/)
9 Cn
M 0
Z
z
-4
X
U)
z
0
M
7,
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
ITI
Slab Insulation ..........
PLUMBING:
0)
:E
Underground .............
0 M
C
0
Rough -In ................... M 0
0
Commercial Final ......
M
HEATING: M Z
vl�
Gas Test ... C z
.................
Gas Piping ................. x
Equipment ................. 0 -n
n
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING .......................... F_
0
M
C
FRAMING ........................
Q 0
Z
FIRST FLOOR FRAMING ...
INSULATION ................... ;U
--I
Floor Insulation ......... 3:
z
Wall Insulation ........... --I
3:
Ceiling Insulation ....... U)
z
0
SHEETROCK NAILING ... I
SPECIAL INSPECTION ... M
MISCELLANEOUS ..........
FINAL APPROVAL, FOR cl. 4
OCCUPANCY ..................