20040717.pdfDATE RECEIVED
ERMIT EXPIRE
FP S A
USE PERMIT
CITY OF EDMONDS 111E NUMBER -7
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS,�
OWNER NAMEINAME =FB6S!NESS
-Paz" 7- 6�) 4U-4 X-r'7 S z- 6 (00 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LM MAILING ADDRESS LID FEE $
TESCP Approved [3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
30: eL/'#/' 5-2'zrj-4 /0 7 street use Permit Roq'd E3
EXISTING — PROPOSED inspocuan Required Q
CITY ZIP ITELEPHONE Sidewalk Required E3
Underground
56-_� 7766 e Od- 77 6 7/ -3 REQUIRED DEDICATION— FT Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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ADDRESS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL-iDRAINAGE E5
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STATE LICENSE NUMBER EXPIRATION DATE CKED BY REO'D POSTED
Z'-"-� J 7 eA1 C- 6 _:� I A, SEPA REVIEW SIGN AREA OYES ONO S HEIGHT
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PROPERTY TAX ACCOUNT PARCEL NO. r f COMPLETE , EXEMPT ALLOWED , PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW E] RESIDENTIAL PLUMBING ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR 1
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COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
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REMODEL MULTIFAMILY SIGN REO'D PROVIDED
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GARAGE RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS�13 ACTIVrM EXPLAIN:
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NUM13ER NUMBER OF CRITICAL OCCUPANT
0a OF DWELLING AREAS SPECIAL iNSPECT16N AREA
1 -3; NUMBER REQUIRED [] LOAD
0 STORIES UNITS YES
DESCRIBE WORK TO BE DONE 0
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION REQ'D
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Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN C2K IN, 0- VESTED DATE Plumbing Base Fee
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Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: IBODAYS
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IL PERMIT LIMIT' I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERL41T FOR MORE INFORMATION
W 'APPLICANr, ON BEHALF OF HIS OR HER SPOUSE, HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt
ALL CLAIMS FOR DAMAGES OF WI IAT EVER NATURE, ARISING DIRECTLY ORINDIRECILY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY oRnINANCE
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
Recording Fee Receipt #
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
GIVEN IS CORRECT; AND THAT I AM THE OWNER, Oil THE DULY AUTHORIZED AGENT OF
LATING CONSTRUC This application is not a permit until signed by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGU CALL isiher Deputy: and Fees are paid, and
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building official or h
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27. OFEIC IG DATE
SIGNATURE (OWNER OtG�ENT�? DATE SIGNED (425)
Z12/1 ';1
SED B
771-0220 DA
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ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL Allh. I t
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL -FILE YELLov�(INP/TOR/
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PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER (501 n . AS';F 'OR
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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