20040700.pdf0
W
t
x
L)
DATE RECEIVED—,
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNE AMEINAME OF BUSINESS
r () Y 0- yl yll
MAIL ING ADDRESS
\ o C) k L4 k Ot— UJ -
CITY
9,0k
NAME
I CITY
NAME
fb L, V e-
ADDRESS
CITY
50- v,
STATE LICENSE NUMBER
N U r-- F-L, * 01
ZIP [ELEPHONE
r- — 'Z
Ci 1k 0 J ') 3 _.�
ek
ZIP ITELEPHONE
CBL #
C % I
- ��j We, k.,j NC—_
�lp TELEPHONE
lzf)(a "s
EXPIHAHON DATE ?IE
I
U
9 -7 K 1- 0 — 6
F]
NEW
g-*RESIDENTIAL
M
ADDITION
M COMMERCIAL
REMODEL
13 MULTIFAMILY
REPAIR
11 GRADING CYDS
DEMOLISH
11 TANK
GARAGE
RETAININGWALL
13 ROCKERY
CARPORT
(TYPE OF USE,
BUSINESS OR ACTIV M EXPLAIN:
NUMBER
_F7
_�U MBER OF
NUMBER OF
OF
LLI
DWELLING
STORIES
TS
UNITS
U IT
DESCRIBE WORK TO BE DONE
USE
ZONE
JOB
I PERMIT EXPIRES
PERMIT
'E
NUMB
SUII,E/APT#
ADDRESS ) , //
/7
PLAT NAMEISUBDIVISION NO LOT NO,
PUBLI I A 0 IC A L �tST KRE E M A!AP
plessurqrelief valveg an api
0
rEX I S T I ROPOSED
K
st S .,o tpnk shall I
I _e aWpansion
-edA
RFQUI (list _ansio
9
13100POLUMBING / MECH
13
COMPLIANCE OR
OF USE
CHANGE
11
SIGN
IFENCE
I
Fri
( x
11
OTHER
FIRE SPRINKLER
1 1
FIRE ALARM
LID NO
LID FEE
, , �od
sC APP
.1 Fjqd
I - - I sm-M JEIJUML�j 10
MEIE11051allummWomma 13r-T-TxiW?"T` PRv z
I YESIDI NO a
W
UPC 1608 z
z
REMAR 6
OWNER/CONIRACIOR RESPONSIBLE FOR EROSION CONIROI /DRAINAGE z
WAgWrIEWED By 'k IndustrIes
41 . te Lrab 0
tr
DATE w
. MEgy[jqj NSP
VARIANCE OR CIO B Rri
T BIT'D
OFPO STIED
s
S
SEPA REVIEW
COMPLETE EXEMPT ALLOAT
" - PEOff E
HEIGHT
ALLOWED I PROPOSED
EXP LOT COVERAGE REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT.)
FRONT LJR SIDE REAR
0
ALLOWED PROPOSED FRONT SIDE REAR
Z
z
z
PA -AV RI�NNM
REO'D Ce S P
By DATE
log
:I
(L
,
buriling PP'9'
,afix
�_nrMARKJ orough U11 ICA co
7-13 P FRO# OCCUPANT
I "C,,E
tCHECKED BY TY GROUP
Cl ANT9
L S
CRITICAL OCCUPANT
AREAS SPECIAL IN7SPECTION WAREA LOAD
R S
NUMBER' REQUIRED M YES
0
REMARKS z
P ER UBC 108/FINAL INSPECTION REO'D F3
ROGRESS INSPECTIONS P
Ito
LUATION
$
Description
FEE Description
FEE
L—L V-
State Surcharge
hL
Plan Check
HEAT SOURCE GLAZIN %
Building Permit
City Surcharge
plumbing
Base F ee
rED DATE
PLAN CHECK NO*
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
MARQUEES, ETC.) WILL REQUIRE
Grading
Engr. Review
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS
SEPARATE PERMISSION.
U PERMIT APPLICATION: 1180DAYS
L PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
ion
Engr. Inspect'
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Fire Review
Plan Chk. Deposit
n 'APPLICANr, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
n AND HOLD HARMLESS THE CITY OF
It IN INTEREST, AGREES TO INDEMNIFY, DEFEND
J IALS, EMPLOYEES, AND AGENTS FROM ANY AND
2 EDMONDS, WASHINGTON, ITS OFFIC
Fire Inspection
Receipt
Landscapelnsp-
Total Amt. Due
L/
M: F WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x ALL CLAIMS FOR DAMAGES 0
* THE ISSUANCE OF THIS PERMIT. ISSUANCE OF 1 HIS PERMIT SHALL NOT BE
FROM
* DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
-1 ABILI1Y 10 ENFORCE ANY ORDINANCE PROVISION-*
WAY THE CITYS
Receipt 0
7 7-
2LL.
0 NOR LIMIT IN ANY
x
Recording Fee
—
—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION� THAT THE INFORMATION APPLICATION AVI-rIUVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF I his application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/tier Deputy. and Fees arc paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED FOR INSPECTION receipt is acknowledged in space provided.
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO i 1� .,
WORKMEN'S COMPENSATION I URANCE AND RCW 18.27. OFFI A DATE
(425)
SIGNATURE (OWNER Oh AGENT)
771-0220 RELEASED
EXT 1333
ATTENTION
IT IS UNLAWFUL TO USE OR
OCCUPY A BUILDING
OR S TRUCTURE UNTIL
A CERTIFI-
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL
OR
CATE OF OCCUPANCY HAS
BEEN GRANTED. UBC
SECTION 109
ARE
MAKING 4 COPIES
09iO3
PRESS
HARD -YOU
ORIGINAL -FILE YELLOW- INSPECTOR
PINK OWNER GOLD - ASSESS013
z
0
1
0
M
-n
M
M 0
0
C)
0
X M
M Z
JD
C
x
W
0 T1
n x
>
M M
0
0
0 M
M C)
Z
z
Cn
z
0
M
'RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
F,60tihg ................. i ....
Wall ........ : ...............
Pier/Porch .................
-Wall
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
'Final .......
Commercial
HEATING:
t
-d
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 ..................
0700
z
0
A
0
M
-i -n
M
C
M
0
-40
0 C
M
M Z
0)
0 -n
n
M M
0 _0)
0 r-
0 M
C 0)
0)
Q C-)
Z
z
0)
z
0
M