20040660.pdf0
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DATE RECIFIVED -7
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY
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NAME
CITY
ZIP rF1 EPHONE
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UG.1 I PERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB SUITE/APT#
ADDRESS
NAME JCBI_t�
194- (.1 7 1P C
ADDRESS I
6!� :� / 5/ K �J I- A L/
CITY ZIP TELEPHONE
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CKPP BY
STATOLICENSE NUM13ER F )ATE AL�x CHE 1�
PROPERTY TAX ACCOUNT PARCEL NO.
005_607000OZ30C
NEW
13 RESIDENTIAL
PLUMBING / MECH
ADDITION
pr COMMERCIAL El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYOS
FENCE
( x Fr)
DEMOLISH
TANK
OTHER
EiGARAGE
o RETAINING WALL
FIRE SPRINKLER
ALARM
CARPORT
ROCKERY
FIRE
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NUMBER OF
CRITICAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
DESCRIBE�WORK TO BE DONE
If I
I
7— / S �eE z 4 .4
a
PLAT NAME,SUBDIVISION NO LOT NO LID NO
LID FEE $
PUBLII RIGHT OF WAY PER OFFICIAL STREET MAP RW Pairrill Roquiled
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EXIST11 G CrrY A� 1k
?Tbp Ir-D PLASTIC' =04111
'WN — 5 M
RFOU11I EDWZ =11PRO,
METEjslzE � a 4r a LIRF MZIT�- -b - [ - rm fmuvv�v - —
PIPING 19 SED FOR ELECTRICA
REMA Skl ",VUr4L)11'4U Ktt-LAI�LN=i-41
OWNE C2M6W.=..._ 4PAAS (bT
604.9.) A STAT.173 ELPECTRICAL PER.N/JT A
I INSPECIION IS REQUIRED IF ELECTRICA
�_NGIN R1118112WEV7ED'By-�0 'W "1 8 s� � �� %1� 4 UA Pt:�
DEPT Of, LABOR& ENDUSMUESEL
FIRE IVI DA
VARIANCE OR CU
SEPA R6l179W&%3LJt
COMPLETE
EXP Sg'L BE
FA 11 R1111TV1 1� t1*14111CF41,
PARKING
REO'D I PROVID
CHECKED BY
SHORELINE OR ADB# INSPECTION BOND
REQ*D POSTED
0YES ONO S
ff-TWWWA605.21 HEIGHT
L,nwr
'a
1,"LaWr,A, UMPQSED__j ALLOWED . PROPOSED
LOT AREA I PLANNING REVIEWED BY
�911ANT tO UPC 608
sHA1,LUE INSTAILED NEAR
-nWWATERSHMFF
) SETBACKS (Fr.)
UR SIDE REAR
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z
DATE
5
IL
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YE LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC I 08/FINAL INSPECTION REaD a
j
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % i 6r-A / ;_1
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fe e
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 Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
ul PERMIT APPLICATION: 100DAYS
IL PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
in 'APPLICANT. ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY DEFEND AND HOLD HARMLESS 1HE CITY OF
EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt N
0: -
< ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIREC rlY OR INDIRECTLY
x FROM THE ISSUANCE OF [HIS PERMIT, ISSUANCE OF THIS PERMIT SHALL NOI BE
a DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscape Insp. Total Amt. Due f2
i OVISION"
0 NOR LIMIT IN ANY WAY fHE CITYS ABILITY 10 ENFORCE ANY ORDINANCE PR
ml - Recording Fee Receipt # ;?147TO_4�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT� AND TliAT I AM IIIE OWNER. OR THE DULY AUTHORIZED AGENT OF
THE OWNER I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- I his application is not a pe(mit until signed by the
I ION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official 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 I
WORKMEN'S COMPENSATION INSURANCE AND RCW 10 27. FI S SIGNAl E E
SIGNATU�"WNER 1101 AG DATE SIGNED (425)
_zz_ LL,
0(/ 771-0220 .1 _ASFD BY� bATE
ATTE*fION EXT 1333
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
09,'03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .......................
-FO
UPDATION:
FooPine .� ....................
Wall......... ................
Pier/Porch,...vr ............ . z
0
--1
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING:
UndergroOtld-� ............. 0 M
M
0 ...........
0 C
Commercial Final ......
M
HEATING: M Z
C=
Gas Test .................... z
dYa's Piping
o -n
Equipment ................. n
--I
Commercial Final .......
M M
EXTERIOR SHEATHING 0
NAILING .......................... 0
0 M
Cj)
FRAMING ........................ (n
M 0
Z
FIRST FLOOR FRAMING ... --I
INSULATION ................... ;U
Floor Insulation ......... >
z
Wall Insulation ........... ---1
Ceiling Insulation ....... Cn
z
0
SHEETROCK NAILING ... I
0
SPECIAL INSPECTION M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................