20040744.pdfDATE RECEIVED
ID
o
PERMIT EXPIRES
CITY OF EDMONDS
USE PERMIT -`7
ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
JOB
ADDRESS
:,SUITEIAPT#
(__J
OWNER NAME ME OF BUSINES
-t --_ 7Z t, j5 4:--fz iI_-,
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
UJI
MAILING ADDR ESS
0—
7 q)- 7 P`y
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
I ESCP Approved E3
RW Permit Roquand 0
EXISTING � PROPOSED
Street use Permit Roq'd [3
Inspection Required 0
Sidewalk Required 0
CITY ZIP
TELEPHONE
7S 7 ��6 Ytr
REQUIRED DEDICATION— FT
Underground 0
Wiring required
NAME
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
6
YES NO
to
ADDRESS
REMARKS
L)
ir
OWNfR/CONTRACTOR RESPONSIBLE RaR EROSION CONTROLIDRAINAGE
CITY ZIP
TELEPHONE
NAME
-7,),)Ig!��
CBL4
cc
0
ADDRESS
&,fc 16
/Vo r,
11
0
Cj
CITY ZIP
'>
TELEPHONE
I
—2 67 - o 0 7S-
STATE LICENSE NUMBER
EXPIRATION DATEI-7—
K11461� c 172 mli
PROPERTY TAX ACCOUNT PARCEL NO.
C/ C'711-crl r,'C�000S 00
_j
NEW RESIDENTIAL
PLUMBING / MECH
ADDITION COMMERCIAL
o COMPLIANCE OR
CHANGE OF USE
REMODEL MULTIFAMILY
SIGN
GRADING FENCE
REPAIR CYDS ( X FT)
DEMOLISH TANK
OTHER
z,
E] GARAGE RETAININGWALL
CARPORT ROCKERY
FIRE SPRINKLER
FIRE ALARM
`� t
(TYPE OF USE, BUSINESS -QEL-ACTIVITY) EXPLAIN:
rj NUMBER 14UM13ER OF CRITICAL
I a
M OF DWELLING AREAS
to STORIES UNITS [NUMBER IJA
DESCRIBE WORK TO BE DONE
1,eAIL
t4A//) 2q 6-A _S,7hwz)jA1�4_
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
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
SEPARATE PERMISSION.
UJI PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT: I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
9 U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIF'� DEFEND AND HOLD HARMLESS THE CITY OF
2 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 THIS PERMIT SHALL NOT BE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENI OF ANY CITY ORDINANCE
1110 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
SIGNATURE tr&WNe"R A416fin/-/ I nATF: qir.mr:n
ENGINEERING
DATE
cc
III
z
z
G
z
UJI
FIRE REVIEWED BY DATE W
VARIANCE OR CU SHORELINE OR ADBI I INSPECTION BOND
RECI'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE EXEMPT ALLOWED I PROPOSED ALLOWED I PROPOSED
EyP
..... I
LOT COVERAGE REQUIRED SETBACKS (IT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR C5
z
z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REO'D I PROVIDED I I IL
REMARKS
CHECKED BY I T)W OF
SPECIAL INSPECTfO
REQUIRED [:] YES
REMARKS
PROGRESS INSPECTIONS PER USC 108/IBC109
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTIO
(425)
-771 n*3s3
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
a
z
FINAL INSPECTION RECI'D
-1 /,V; S 1, <:7
Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
ROVAL
APPLICATION APP
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 provi . d.
+J4(S�IGNATURE A
oil E EASED BY �L77—
�ATE
ATTENTION DIU 1333
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTI LA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
ORIGINAL -FILE YELLOW. INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER GOLD-ASSESson
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
4
0
M
=i 9
M
M 0
0
0
0 C::
—4 r,
X rn
rn Z
co
o -n
n
MM
0 5
0 r-
0 M
C U)
9 Cn
M 0
Z r-
z
--I
X
(j)
z
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation .......... 'A
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 ...
R g— rge J/1A �t
MISCELLANEOUS ..........
FINAL APPROVAL FOR /V Z::�
OCCUPANCY ..................
The initials MT are Miltoll
Thompson, a temporary colitract
illspector for thc CitY.
z
0
1
0
M
-n
C ITI
M 0 1
0
0
0 C
M
M Z
--I
z
0 -n
3:
M M
0
0 M
C
C C/)
Q 0
Z
>
z
3:
z
0
--I
M