20040705.pdfI
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l/A. 74 1 [PERMITEXPIRES
LISE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB
ADDRESS
OWNER NAMEINAME OF BUSINESS
�1 E5 -�DA�A t>UV,� PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
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M MAILING ADDRESS LID FEE S
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z TESCP Approved
3:
0 tO 2�0 N15,, PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
Street Use Permit floct'd
CITY ZIP TELEPHONE EXISTING - PROPOSED inspection Required
underground
Sidewalk Required
'?b92,6,, 4-2 5-- 77/. 0 t's REQUIRED DEDICATION- FT Wiringtoquirod C
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONIROLJORAINAGE
CITY ZIP TELEPHONE 6AS Pliff TESI MUST BE
NAME CBL is OBSERVED BY mirry INSPECTOR
1-7171 ENGINEERING REVIEWED BAFFIDAWS SMALL M
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0 BE ACCEPTED
FIRE REVIEWED BY DATE
0 CITY
wojs
ZIP
41�_t
TELEPHONE
104-2_'�_ 7 74 7 17
STATE LICENSE NUMBER
EXPIRATION DATE
BY
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PROPERTY TAX ACCOUNT PARCEL NO.
100, S4-X9 � 4D 00 0 2-7D-1--
NEW
XRESIDENTIAL
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PLUMBIN / MECH
A,
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING FENCE
CYDS I X FT)
DEMOLISH
TANK
OTHER
GARAGE
RETAINING WALL FIRE SPRINKLER
CARPORT
ROCKERY
FIRE ALARM
(rYPE OF USE, BUSINESS
le"Jer
9R ACTIVPQ EXPLAIN:
Aec. -
NUMBER
OF
STORIES
NU MBER OF
DWELLING
s
CRITICAL
AREAS
NUMBER Ajq---
DESCin WORK T9 BE DONE
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HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS PERMIT SHALL NOT BE
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
X_
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 LAReR_C'RDE OF THE STATE OF WAS14INGTON RELATING TO
WORKMEN'S COMPENSA71ON INSUaANCE AND RCW 18.27.
DATE
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VARIANCE OR CU SHORELINE OR A11111 I INSPECTION BOND
REO'D POSTED
OYES 0 NO 1 $
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/RSIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED BY 11;PQ U)CTION coDq OCCUPANT
"n GROUP ;� 2::)
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SPECIAL INSPECTION AREA OCCUPANT
M
REQUIRED [:] YES LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108 / IBC109 IRC109 FINAL INSPECTION REQ'D
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENTION E)ff 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/1RC110.
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
I
OFFICIALS ?IGNAYURI
DI"'T E
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RELEASED
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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SETBACKS .....................
FOUNDATION:
Footing ......................
Wall............. ......
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
commercial Final ......
HEATING:
GasTest ....................
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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