20040667.pdf6
DATE RECEIVED (�) /
PERMIT EXPIRES i.A., Inuz -At)
US E PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
Pi_ 04 C. C,--
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
cc MAILING ADDRESS LID FEE $
W TESCP Approved E3
z RW Permit Required 13
3: i 1_2> o j-�'/ if PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 Street Use Permit Roq'd 0
EXISTING � PROPOSED inspection Required 0
CITY ZIP TELEPHONE Sidewalk Required [3
6_ -9, REQUIRED DEDICATION— FT Underground 0
METER SIZE LINE SIZE NO. OF FWURES PRV REQUIRED
NAME 0
YES ID NO 13 z
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U3 REMARKS z
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x OWNER/CONTRACTOR RE
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CITY ZIP TELEPHONE addition to the required
ressure/relief valve, an approved
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NAME listed expanSlOrl
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0 LjPC 608
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VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHECkED BY REO'D POSTED
W0 /'z- r7-/' Z. C, SEPA REVIEW SIGN AREA OYES ONO IS HEIGHT
-j PROPERTY TAX COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED , PROPOSED
ACCOUN_I�IPARQE C,
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LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
PLUMBIN / CMEC d FRONT SIDE R11 FRONT IR SIDE REAR
13 NEW RESIDENTIAL ALLOWED PROPOSED
r__j COMMERCIAL COMPLIANCE OR _E 1'EQT MUSTIBE
13 ADDITION CHANGE OF USE GAS, 1? r*4 z
PARK NtN DATE 5
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1:1 REMODEL MULTIFAMILY SIGN REO'D I= ffirly 011 1 y SPERVOR
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GRADING FENCE
REPAIR CYDS ( x FT) REMARKS
DEMOLISH F� TANK El OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY El FIRE ALARM
(TYPE OF USE, BUSINESS TIVI 'E X PPI
I Z CHECI�ED By RUCTION E OCCUPANJ
FC 115 GROUP
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0 T
w NUMBER NUMBER OF CRITICAL
0 DWELLING A 1A LOAD
OF R S SPECIAL INSPECTION AREA OCCUPANT
M UNITS NUMBER REQUIRED [-
0 STORIES I �' f.�_ I _] YES
DESCRIBE WORK TO BE DONE OW t5tCt
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RROGRESS INSPECTIONS PER UBC 108/ IBC109 /IRC109 FINAL INSPECTIONREQ'D
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on FEE
/AVL1 09�' Description FEE Descr pti
R((,—. AbLi- Plan Check State Surcharge
HEAT SOURCE G-WING 4 LOT SLOPE % Building Permit City Surcharge 15—
Base Fee
PLAN CHECK NO: VESTED DATE Plumbing
-I
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI, ON BEHAi F OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMI ESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS. EMPLOYEES, AND AGEN IS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTIY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHAH NO] BE
Landscapelnsp. Total Amt. Due 0'5
_j DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION "
x Recording Fee Receipt # Lf 7z
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION. THAT 1HE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF I hisapplicallon is not a perinit until signed by the
THE OWNER. I AGREE TO COMPLY WIT) I CITY AND STATE LAWS REGULATING CONSTRUC CALL Building Official or hisitier Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF I HE STATE OF WASHINGTON RELATING TO FOR INSPECTION ioccipt isacknowledged inspace provided.
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WORKMEN'S COMPENSATION1 INSURANCE AND RCW 18 27. OFFI A[ GNATURF// 1E
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SIGNIUR (O'X4NER 0 A T) DATE SIGNED (425)
L, 6, 771-0220 A A, ED BY QhTE
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SINTION EXT 1333
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ITISU LAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/[BC110lIRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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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