20040628.pdfINKII94
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
PO 1 #,-� 7 Lz_ It-, L
MAILING ADDRESS
CITY
ADDRESS
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CITY
NAME
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ADDRESS
CITY
L'iflit--f STe. 10
ZIP TELEPHONE
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ey Lf-(�"'
ZIP TELEPHONE
CBL 9
L=_71 14 11) 1 9L 10('11 17
STATE LICENSE NUMBER
ZIP TELEPHONE
q��0 '2 35-cl
107 6-q. S
EXPIRATION DATE CHECKED BY
_'41T / 10 / C) , �5— 1 & �/
PROPERTY TAX ACCOUNT PARCEL NO.
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--02 c, 6) 1 o2 6bo
Efo'NEW E] RESIDENTIAL
El ADDITION CO MERCIAL
0
REMODEL MULTIFAMILY
REPAIR GRADING CYDS
DEMOLISH TANK
1 GARAGE RETAINING WALL
:1 CARPORT E] ROCKERY
(TYPE OF YSE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
Dl�*CRIBE WORK TO BE DONE
14
Lo
PLUMBING / MECH
El
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
f X
M OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
7
USE
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JOB
ADDRESS P1
I PERMIT EXPIRES
PERMIT '71MLI
NUMBER
Qtpl
SUITE/APT#
PLAT NAME/SUBDIVISION NO,
LOT NO.
LID NO.
LID FEE $
PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAP
IESCP Approved
RW Permit Required
0
13
Strout Use Permit Hoq'd
13
EXISTING — PROPOSED
inspection Requited
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
E3
wiring required
METER SIZE
LINE SIZE
NO, OF FIXTURES
PRV REQUIRED
0
YES NO
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REMARKS
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
5
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE Lu
VARIANCE OR CU
SHORELINE OR AOB#
INSPECTION
BOND
REO'D
POSTED
___tOYES
qNO
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEW ED BY
DATE
REO'D PROVI
—1-7
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FT) I REMARKS
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HEAT SOURCE GLAZING 9C LOT SLOPE %
PLAN CHECK 0: VESTED DATE
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
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NAT URE, ARISING DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NO] 13E
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..
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
INvi'6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RFLAI ING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27
SIGNAAn DATE SIGNED
CHECKED BY I TYPEiOF CONSTRUCTION
LA P lt�7
T5
E OCCUPANT
�111�5 GROUP
SPECIAL INSPECTION JAREA OCCUPANT I
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC108,1113C109,111110109 FINALINSPECTION REQ'D 2i
5
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
FEE
Descriptibn
State Surcharge
City Surcharge
Base Fee
li�
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt N
LandscapeInsp. Total Amt. Due
Recording Fee Receipt 0
APPLICATION APPROVAL
I tits application is not a pernlit until signed by tire
CALL Building Olficial or hisihor Deputy. and Fees are paid, and
FOR INSPECTION receipt is acknow[Ldged in space provided.
OF FICIALS SIGNATURE DATE
'� � 1
(425)
Z11 q
771-0220 By/ DATE
ATTENTION EXT 1333
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
INAL! FILE YEL/OW-INIPECTOR
K - VNER 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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