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20040621.pdfDATE RECEIVED CITY OF EDMONDS CONSTRUCTION PERMIT APPLICATION OWNER NAME/NAME OF BUSINESS Ajo<.e> 0.4, L (f- MAILING ADDRESS /00 V_-31 x// CITY ZIP TELEPHONE �FRO 2-- NAME ADDRESS CITY ZIP ITELEPHONE —14 / 04 1 1 PERMIT EXPIRES U9E PERMIT ZONE NUMBER JOB SUITE/APT# ADDRESS o au-e .5 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO. LID FEE $ PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP I ESCP Approved AN Permit Required 0 0 Street use Permit Roq'd 0 EXISTING — PROPOSED Inspection Required Sidewalk Required 0 E3 REQUIRED DEDICATION— FT Underground Wiring required E3 METER SIZE LINE S PRV REQUIRED YES NO El UJI REMARKS z z OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5 z Lu CBL NAME WMr ENGINEERING REVIEWED BY DATE a: ADDRESS FIRE REVIEWED BY DATE Lu M CITY ZIP TELEPHONE M 0 VARIANCE OR Cu SHORELINE OR ADBI INSPECTION BOND STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED SEPA REVIEW SIGN AREA OYES ONO I S HEIGHT PROPERTY T 0. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED A�C W P C W A /27 EXP LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.) NEW RESIDENTIAL PLUMBING / MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR COMPLIANCE OR z 13 ADDITION COMMERCIAL CHANGE OF USE z LOT AREA PLANNING REVIEW PARKING ED BY DATE REMODEL MULTIFAMILY SIGN REQ'D PROVIDED GRADING ------- FENCE X I I REPAIR in. y ns ( _ FT) REMARKS §DEMOLISH TANK OTHER �l E3GARAGE RETAINING WALL FIRE SPRINKLER CARPORT ROCKERY FIRE ALARM (TYPE OF USE, BUS,10ESS-fIR AC�IVIM E-XPIIN: CHECKED 13Y ITY CQR GROUP g&Wj7TRUCTION OCCUPANT uj NUMBER NUMBEh OF CRITICAL 0 OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT M LOAD 0 STORIES UNITS NUMBER REQUIRED 13 YES DESCRIBE WORK TO BE DONE REMARKS z PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D M /9 IN� ow 10 Cc VALUATION P4) IJ $ Description FEE Description FEE Plan Check State Surcharge HEAT SOURCE GLAZING % LOT SLOPE % Building Permit f City Surcharge PLAN CHECK NO: VESTED DATE Plumbing Base Fee THIS - PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical t 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: 180 DAYS ul 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 IN INTEREST, AGREES TO INDEMNIFY DEFEND AND [TOLD HARMLESS THE CITY OF M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt # Ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY It x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT BE 9 DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due 0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISIOW4 x I — Recording Fee Receipt # 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 011icial or hisihor 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_59MP OF ICIA AT(R TE kNSATION INSURANCE AND RCW 18.27. SIGNAT (OWNER ENT�/, DATE SIGN D (425) 72' 7 A 771-0220 DAT ATTENTIOk "7 E)ff 133 -OWNER GOLD - ASSESSOR IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOd- INSPECIOR PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK 09/03 PRESS HARD -YOU ARE MAKING 4 COPIES I z 0 ­1 0 M =Illwi Cn —1 x M C: M 0 0 C-) 0 C: --i K X M M z 0­1 C 3: Cn 0 _n n M M 0 C—D 0 17, 0 ITI C: Cn 9 Cn M 0 Z z z 0 ­1 0 1711 a 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 A O's OCCUPANCY .................. zojov�. 444?1 &000- z 0 11 0 ITI -n fn C 171 0 0 fn ITI z 10-4 C o -n n MITI 5) 0 0 ITI 0) W ITI 0 Z 3: z 3: W z 0 0 IT!