20040738.pdfI
DATE RECEIVED
LPPERMIT EXPIRES
USE PERMIT
ZONE
CITY OF EDMONDS NUMBER.
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/�N ME 0 0,
PF USINESS PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
UM MAILING ADDRESS LID FEE S
z TESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
0 Y)
I street use Pemit Roq'd 0
CITY EXISTING - PROPOSED inspection Requited [3
ZIP TELEPHQNE Sidewalk Required 0
_IPJL
fl, Underground
7 REQUIRED DEDICATION- FT
0[ R�-Pj NA, 1/f �,r Wiring required 0
NAME METER SIZE NO. OF FIXTURES PRV REQUIRED
z
YES 0 NO 0
t: ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE 6
z
W
TELEPHONE
CITY ZIP
NAME CBL�#
4
e _
Pj /1& 64
A
0 ENGINEERING REVIEWED BY DATE
ADDRESS
0 tws
0"",g kl/\l
ej FIRE REVIEWED BY DATE
CITY ZIP TELEP ONE
0 0
0 11 1 *1
VARIANCE OR CU SHORELINEORADE111 INSPECTION BOND
STATE LICENSE NUMBER XPIRATION DATE IECKED BY REQ'O POSTED
I)ON 5_0 SEPA REVIEW SIGN AR - EA OYES ONO Is HEIGHT OSED
PROPERTY TAX ACCOUNJ-PARCEL NO. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED PROP
Ul 5 ro ci zip) e) 4�2 EXP
NEW RESIDENTIAL PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR z
z
ADDITION COMMERCIAL Fl CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
REPAIR E] GRADING FENCE
CYDS ( X FT) REMARKS
OTHER
1:1 DEMOLISH 13 TANK F�
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BU
,P4g4a_SACTIVITY) EXPLAIN:
CHECKED BY ITYPE OFrtN(7 I OCCUPAE;
R je--05)1-b FRE�Jt 04'i-�f GROUP
L) - I � 4_�
U) OF
uj NUMBER NUMBER I CRITICAL 0 14 r-ax__
a OF DWELLING AREAS SPECIAL. INSPECTION JAREA OCCUPANT
at NUMBE REQUIRED LOAD
0 STORIES UNITS E] YES
DESCRIBE WORK TO BE DONE C
REMARKS z
PROGRESS INSPECTIONS PER LIBC 108/ IBC109/ IRC109 FINAL INSPECTION REO'D 5
Fl�o b-f.
c�41 Fi Ij 6xf
VACUATION
$
_740 Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
I Building Permit City Surcharge
ECK NO: VESTED DATE Plumbing Base Fee 30
7 ro
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
r t= 13E 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: 180 DAYS
W
CL PERMIT LIMIT'll YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
I SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) '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
M EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
9 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. OR THE DULY AUTHORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- 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 receipt is acknowledged in space provided.
WORKMEN�S CqMPENFATION INSURANCE AND RCW 18.27. r0,,1A_IALS SIGNATURE DATE
DATE SIC)NED
SIGN4URE OR AGENT) (425)
0 W r'' 0 7
71-0220
RELI�ASED BY-- D/�E
ATTENTION r.A I I
ITIS UNLA\AIFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR ACERTIFICATE 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
z
0
11
0
M
—i -n
M
C
M
0
0
0 C
rn
M Z
01
C:
x
(n
0 -n
n
—4
x
M M
0
0
0 M
C 0)
r, C/)
Q C-)
Z
7-1
z
W
z
0
i
0
M
I
M!
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 ..................
0 o q.
z
0
1
0
M
-4 -n
C/)
r
0 M
C i I
M 0
0
0
0 C:
M
M z
C
o -n
n
M M
0
0
0 M
C Cj)
C C/)
M 0
Z
;U
__I
z
—4
x
0)
z
0
0
M