20040623.pdfDATE RECEIVED
PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE fi) N U M B E FI
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CONSTRUCTION PERMIT APPLICATION JOB '7� SUIT�iJAPT#
OWN ADDRESS Z
��P-�KME/NAME OF 13USINESS
Iry V) PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
I z -AILINU ADDRESS LID FEE $
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IESCP Approved 13
0 PUBt IC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Roquised 13
street use Parnill Roq'd 0
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required E3
Sidewalk Roquited E3
REQUIRED DEDICATION� FT Underground
6744 1 Wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
YES 13 NO 13
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REMARKS z
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLYDRAINAGE F3
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CITY ZIP TELEPHONE
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I- ENGINEERING REVIEWED BY DATE
0: A�RD
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FIRE REVIEWED BY DATE W
CITY zip TELEPHONE
INSPECTION BOND
STATE LICENSE NUMBER EXPIRA ON DATE Cl- CKED� qY VARIANCE OR CU SHORELINE OR ADS#
REO'D POSTED
7, OYES 1360 S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALL ED PROPOSED ALLOWED PROPOSED
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ILI 2,
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/fV , / 111 j - EXP I I
NEW RESIDENTIAL PLUMBING/MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR 0
ADDITION COMPLIANCE OR
COMMERCIAL z
CHANGE OF USE z
PARKING ILLIT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY
4:13 -��SIGN REQ'D I PROVIDED 7
GRADING FENCE
REPAIR CYOS X FT) REMARKS
DEMOLISH TANK F� OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS; 0 ACTIVITN2EXPLAIN:
Fr . " BY ITYPE PJSCp�DTRUCTION I COO E5, OCCUPANZT
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Lis NUMBER NJMBER( CRITICAL
OF DWELLIN AREAS SPECIAL INSPECTION JAREA OCCUPANT
0 STORIES c�2 UNITS NUMBER REQUIRED [] YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
ESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
PROGR
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41
d22 - - re_-_ - 0 14
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
CK NO: VESTED DATE Plumbing Base Fee
4�d._ Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
W
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
(A
W IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
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2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECIIY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT HE
0 DEEMED -To MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapeinsp. Total Amt. Due
_1 1 9
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee I Receipt # Y)f �9
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 APPLICATION APPROVAL
THEOWNER. 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 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.
IIAL� Sib I ATURE DATE
N URE WNER 0 ATE NXED
A (425
R ED BY
771-0220 1 YATE
ENT/f0h EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUIL 17NG '®RSTRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPE LR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
091/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ........... 0
ITI
Slab Insulation ..........
PLUMBING: —i -n
Underground ............. M
C 0
Rough -In ................... 0
0
0 C
Commercial Final ...... --I K
x M
HEATING: M Z
C z
Gas Test .................... >
r
Gas Piping ................. C/)
o -n
Equipment .................
Commercial Final ....... x
M M
EXTERIOR SHEATHING 0
0
NAILING .......................... 0 M
C C/)
FRAMING ........................ 9 Cn
M 0
Z
FIRST FLOOR FRAMING ... 71
X
INSULATION ...................
Floor Insulation ......... >
z
Wall Insulation ...........
Ceiling Insulation ....... z
0
SHEETROCK NAILING ...
SPECIAL INSPECTION ... 171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
00