20040642.pdfU
DATE RECEIVED
C1W OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF PUSINESS
TP) 1_71, A A A A I A A A v-*f V 4r-
MAILING ADDRESS
CITY
NAME
I CITY
('� I Yv—
n
S
1)7 Vdinier.
NUMBER
rELEPHONE
I
ZIP I TELEPHONE
PROPERTY TAX ACCOUNT PARCEL NO.
1-'-V� C---)
1L.AJ,_ 44-1
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NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
E]
RETAINING WALL
CARPORT
ROCKERY
F USE, BUSINESS OR ACTIVITY) EXPLAIN:
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& [ ERMIT EXPIRES
PE
USE' PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
ily A
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO
LID FEE S
PUBLIC RIGHF OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Roqijuod 13
Street Use Permit Roct'd 0
EXISTING - PROPOSED
inspection Roqtjjrod Q
sidewalk floquirod E3
REQUIRED DEDICATION-- FT
underground
13
wiring (equiroa
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES 0 NO
cc
Lu
REMARK
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"16RACIOJ RESPONSIBLE FOR4RgI.ON NTR40"L/o IN GE
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1.1%., 1� , rc eo
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I through unhented wlleola, IMC 803.2
CBLI 0
r, A R ID! P&
its�_Msi ENGINEERINffrl�wffi EN TEST MUST_
z I 0C DATE
SERVED BY CITY INSPECTOR
FIRE REVIEWED%1'1-!LJAVI IN SHZI I iv nT DATE
17-1
PLUMBING /LK CECH:)
COMPLIANCE OR
CHANGE OF USE
E] SIGN
FENCE
( X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
uj NUMBER NUMBER OF Lj -4 _ffiCAL
I CR
OF DWELLING AREAS
0 STORIES UNITS NUMBER
Oil to gas furnace 800 000 40W
located recroom of inain resiclence
Gas Water Heater-'Amn btu
LA/
located recroom or /nain residence
Approx I ' ft new gas pipe
(stubout for future stove)
Tankless water heatetiff,(60(-) btu
locatedo u ()ICLE , ef rear unit
')IC C,
H AT_S6_ GLAZING %
E liRCE LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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.
PERMIT APPLICATION: ISODAYS
PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS
U)
IN INTEREST, AGREES 10 INDEMNIFY, DEFEND AND HOLD HARMLESS THE C, Ty OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
Ir
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL N01 BE
DEEMED TO MODII`71� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE C11YS ABILITY 10 ENFORCE ANY ORDINANCE PROVISION.'
=1 -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTIIORIZED 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 THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGRATURE (OWNER OR AGM)T
DATE SIGNED
-I - I 11_�, - C 14
BE ACCEPTED
VARIANCE OR CU SHORELINE OR ADB# IN PECTION
REO'D
OYES [INC
TREVIEW SIGN AREA
C t"i all�`v`7 4�1,tjjem Plit(r"�t 1117"
EX � T � !-. ] �" 3 - 'T lfv�LC+ACIJ
SETBACKS (Fr.)
11.
M
BOND
POSTED
PROPOSED
I SETBACKS IFT'
LIR 'IDE REAR
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JIDATE
installed on all hot water tanks,
UPC 608 1
CHECKEDBY ITYPEOFCONSTRU [ON I OCCUPANT
ryGROUP
SPECIAL INSPECTION ]AREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS
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PROGRESS IN�PECTIONS PER �113C 108/FINAL INSPECTION REQ'D 15
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12 Ah 11 Y) I IL il (L- r;o I al
VALUATI
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description
State Surcharge
City Surcharge
�) 0
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION EXT 1333
FEE
15 -oo
7- 's 0 - c) �)
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a perniii until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided,
I I A S SIGNATU 'ATE
S
EASED BY DArE
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
04/02 PRESS HARD -YOU ARE MAKING 5 COPIES GREEN - ACCOUNTING
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RECORD OF INSPECTIONS
INSkCTOR DATE APPROVED
SETBACK S ....................
FOPNOATION:
�Ooling
...........
all
Pier/PpIcH
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Undergroun .............
Rough�ln-A.% ...................
Cohi t mercial Final . ......
HEATING:
Gas Test .....................
Gas Piping .................
Equipment .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
FRAMING........................
FIRST FLOOR FRAMING...
INSULATI.ON .... I ...............
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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