20040694.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
01.1 NAME/NAME OF BUSINESS
MAILING ADDRESS
PL Vff"3�
CJj1Y cz, P I TELEPHONE
t:�AMCK-Nc�s
NAME
ADDRESS
ZIP I TELEPHONE
NA31
riv "I
CBL
ADD14ESS
ZIP
LEPHONE
�3' TE LICENSE NUMBER EXPIRATION DATf CHECKE oy
PROPERTY TAX ACCOUNT PARCEL NO.
MHj1jC11,L1 (Dot) C)D(P
NEW RESIDENTIAL
10
PLUMBINGEMECH)
ADDITION COMMERCIAL
COMPLIANC
CHANGE OF USE
FIPEMODEL MULTIFAMILY
SIGN
REPAIR GRADING
CYDS
Ei
FENCE
( — X�FT)
DEMOLISH TANK
OTHER
EGARAGE RETAINING WALL
I E]
FIRE SPRINKLER
ALARM
CARPORT ROCKERY
FIRE
OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
gn
I t
w NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
0 STORIES UNITS NUMBER
DE�CRIBE WORK TO BE DONE
k
HEAT SOURCE GLAZING % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Lu PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT: I 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
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
01 NOR LIMIT IN ANY WAY THE CII`YS ABILITYTO 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND A RCW 18.27.
GNATURE (OWVER OR I E SIGN
;ilZ�kn .� . 6
MAI'�_Lb [VAIX, IT/, ) -4—
it
USE
ZONE
JOB
ADDRESS
150
PLAT NAME/SUBDIVISION NO.
PERMIT EXPIRES r
PERM'T
NUMBER
LOT NO. LID N
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- IFT
METER SIZE I LINE SIZE I NO. OF FIXTURES
PRV REQUIRED
YES 0 NO 1:1
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
in Ei lectrIcal
,15,Mbri & 11
FIRE REVIEWED BY
DATE
0
Z
M
W
z
z
6
z
W
Lu
M
11L
....... NCEORCU SHORELINE: ORADB# INSPECTION I BOND
REO'D POSTED
OYES ONO 1$
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
z
z
z
lypaiN11:11i or
LMIAA C eawalmqtph-ed I ATE IL
I Efi
IDED
-�epmvmrn ng appli nces Passing
Ir 74
F EWIt"gill unliented sj)nven. UUM03.2
CHECKED BY ITYPE
GROUP j
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ D �
VALUATION
Description
Plan Check
Building Permit
Plumbing
Grading
Engr. Review
Engr. Inspection
FEE Description
rSt,ate Surcharge
ty
ity SurC`harge
FEE
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
la '.)
Recording Fee Receipt N 12
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
OF N i RE DATE j
CI -S IG ATU
(425)
2Ti
771-0220 ASED BY DATE
ATTENTION t:x I . .. . .. .....
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
z
0
1
0
M
--I -n
M
M
0
C-)
0 C:
--I K
2: M
M z
0-4
C _z
o -n
M M
IC) F)
0 r-
0 M
C (1)
90)
M 0
Z 17-
z
z
0
M
0.
LID FEE $
TIESCP Approved
13
RW Permit Required
13
Street Use Permit Req'd
13
Inspection Required
13
Sidewalk Required
13
Underground
wiring required
E3
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
z
0
Retaining Wall ...........
0
M
Slab Insulation ..........
-n
PLUMBING:
Underground .............
M
C
M 0
Rough -In .....
0
C)
0
C
Commerciai1.FInaI',-.,.'iA.
M
..,."HEATING:
M Z
ID --I
C: z
Gas Test ....................
>
Gas Piping .................
0 _n
Equipment ...............
f
Commercial Final .......
M M
J
0 Cn
EXTERIOR SHEATHING
0 r—
NAILING ............................
0 IT11
C Cn
9 co
FRAMING ........................
Q 0
Z
FIRST FLOOR FRAMING ...
;U
INSULATION ...................
Floor Insulation .........
z
Wall Insulation ...........
:E
0)
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
_q
0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile initials MT are Miltoll
Thompson, a teillporary contract
inspector f6l. the City.
42
00 tj ,, 0& ? Z/ vo-,�