20040736.pdfDATE RECEIVED
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L-2—lo4 I PERMIT EXPIRES
USE PERMIT
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SU APT#
OWNER NAME/NAME OF BUSINESS ADDRESS INU
(_)f V PLAT NAME/SUBDIVISION NO, LOT NO. LID NO.
MAILING ADDRESS LID FEE $
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Z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP TESCP Approved 0
RW Permit Required El
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10 1,� 1� Street Use Permit Req'd 13
CITY ZIP EXISTING — PROPOSED inspection Required [3
Sidowalk Required E3
TELEPHONE REQUIRED DEDICATION. FT Underground
witing required E3
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NAME METER SIZE LINE SIZE FIXTURES PRV REQUIRED
YES[J NO
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ADDRESS REMARKS Z
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OWNERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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CITY LEPHONE
NAME CBL#
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ADDRESS
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FIRE REVIEWED BY DATE W
CITY zip TELEPHONE
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0 N-Y, �Iy�l C 9 t�dcr)3 (01*1 VARIANCE OR CU SHORELINE OR AD1111 INSPECTION BOND
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COMPLIANCE OR Z
ADDITION COMMERCIAL Z 0 M
CHANGE OF USE Z C 0
PARKING LOT AREA PLANNING REVIEWED BY DATE M
El REMODEL El MULTIFAMILY SIGN REQ'D I PROVIDED 0
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GRADING El FENCE _GA PIPE TEST MUST BE 0 C:
REPAIR C Y DR, X FT) REMARKS 4 K
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DEMOLISH TANK OTTER owgur) ny ciTy wspmm M Z
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uj NUMBER NUMBER OF CRITICAL M 0 0
OF DWELLING AREAS SPECIAL INSPECTION 'JAREA OCCUPANT n
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0 STORIES UNITS NUMBER REQUIRED LOAD
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DESCRIBE WORK TO BE DONE M M
REMARKS 13
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION RECI'D 0 r-
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VALUATION
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Description FEE Description FEE >
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Plan Check State Surcharge _1
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PLAN CHECK NO: VESTED DATE Plumbing Base Fee 0
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Mechanical ITI
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
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 Landscapelnsp. mt. Due
0
9 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0 Receipt #
_. Recording Fee 4? IF
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION I
GIVEN IS CORRECT; AND THAT I AM THE OWNER. OR THE DULY AUTHORIZED AGENT OF APPLICATI1 WAI
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIRUC- CALL This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION,__N receipt is acknowledged in space providedi
VVUtHiKMtN'b OMPENSATION INSU - RANCE AND RCW 18.27. OFFICtS IGNATURIJE D.,VTE
SIGNATURE (OWNER OR ENT) DATE SIGNED
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fo- I( jq� 771-0220 BY DATO I
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
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
wT— 4- 6_5
OCCUPANCY ..................
2COq w,63 3LQ w000e
The Initials MT are Milton
Thompson, a temporary contract
inspector For flic CitY.
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