20040746.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINE S
GP,AHAM 1 va,-rdWEs-r
MAILING ADDRESS
2n O�o
CITY
NAME
'NF -SI-T
ZI PHONE
2.!S� - -1 `2� - 7-
ZIP
TELEPHONE
NAME CBL#
-sm"kE
ADDRESS
'A/ /)/19
CITY ZIP TELEPHONE
STATE LICENSE NUMBER
6i�9414A�J I o4
PROPERTY TAX ACCOUNT PARCEL NO.
W2 9
EXPIRATION
'A I Mj
F496
0
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER ZQ0L4 -
JOB
ADDRESS
7 /X
Zo
J
S
E
N
3
E
fAODDRE
S
PLAT NAME/SU BDIVI SION NO. LOT NO.
Lui:r-, 2-
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP R
s
EXISTING — PROPOSED In
s
R Out
REQUIRED DEDICATION— FT u
I 1W
M M T
ETER SIZE LINE SIZE NO. OF FIXTURES
BY
NEW
--fc-1/1"IESIDENTIAL
PLUMBING / MECH
ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
ryn's
FENCE
x Fr,
DEMOLISH
El TANK
OTHER
EiGARAGE
CARPORT
RETAININGWALL
13 ROCKERY
FIRE SPRINKLER
FIRE ALARM
I[TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Lu NUMBER NUMBER OF CRITICAL
0 OF DWELLING AREAS
UNITS
0 STORIES NUMBER
DESCRIBE WORK TO. BE DONE_
S--A &
SUITE/APT#
C
LID NO.
LID FEE $
ESCP Approved
W Po(md Required
Inter Use Permit Roq'd
specuon Requited
idowalk Required
ndotground
inngfequired
PRV REQUIRED
YES El NO 13
REMARKS
OWN ER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
Lu
z
z
5
z
ILI
FIRE REVIEWED BY DATE Lu
M
LL
VARIANCE OR CU HORE INE OR ADS# I INSPECTION BOND
REO'D POSTED
OYES ONO 1$
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
z
z
z
PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE
GROUP/e
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
z
1PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REaD
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO* VESTED DATE Plumbing Base Fee
Z
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 Grading
3 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION. Engr. Review
Lu PERMIT APPLICATION: 180DAYS
IL PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANI ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTERE�r. 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
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENr OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION.,
x Recording Fee Receipt #
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 APPLICATION APPROVAL
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 011icial or his/her Deputy: and Fees are paid, and
IN VIOLATION-�QF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'SPOM.PY4,SATION INSURANCE AND RCW 18.27.
OFFICIALS SIGNATURE DATE
6VE 1, DATE SIGNED
I TUBE (1,�w (425) r: 2LI,�9zl
771-0220 R-1 -D BY DATV
ATTENT19W E)ff 1333
-17 1 ox
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
Z"WZIL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INS(ECTOF(
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER - GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
1
0
M
--i -n
Cl)
0 M
C
IT!
0
10
0 C::
M
M Z
g) —4
c:: —z
M
cf)
o -n
n
M M
0 C—/)
0 r-
0 M
Cf)
Cn
M 0
Z
X
--I
r
z
z
0
i
0
M
ZONE
SETBACKS:
FRON
tj 319( .301+
C-5 D�71AP11-1:0 'XN -
SIDE LX1. Z40
I C2 'F= Z-7-K- S4 -7— c? 0.-7 0 1 N 0 N
OTRIER AJA,-i F-F-
F=7?-, -DMAJ )'I
H1 TeX- LIU
AP�ROVED BY ENOEERIN�G
7r' TS
L
45PA
0 L U
-4-4411
a tj j
T V- r-= Lot,,%: Z-1 0 7-'�
Date: 1� 2(/D 10 1 \Aj lb G- F= "ro
V F / 1 Fz.7-
SLO IE
s I L--r. V7 m Lo co 0
uj
w
IL P, q �kj/ WA R/& s4m
Y I I ( 0,]>E. v Iro 0 Ga--
)W 140/6 Fo
P
.t
IT Sw FV r�--M L I IF- I'VE K INSP
IONS QE YD
-771-022rEAT. 1326,
-n: z cn M
ALL EXPOSED SURFACES T Dvp 00,
E COVERED WITHIN 2 DAYS-- FEE m MA�asu -r ff F 843
ITH I -�c 1 4h- W
A 0. c� cn
OWN,, R/C0NT�:LAC"'f'(j1'1 IS RESPO rs)'IR-L.E APPROVED BY PLANNItAci m
A #-- F' -------- - ------- -
r.r,.,i F-ric —o,�-1
., . .. .1 1-1 c'A'L-c-
a c--r 70 C-L.MA44 -0 V-r-
A 7- 9, 0 0 1 me mr- fjT-e, o r-
H Q 0 K-F H 67- Iao�� 10
P Lz-.::: Z-s o 0-s-'--003
0 �n (I'll "p Z_ -3 9. _G7 V-11 L-,�,SUF-S-5 E;L-uf=r-- cz, u 3>
-FAx. -0- 7- 70 S Z-500 AO(
Lu 0 D� J> ---
cc ( 1:3 f 1-,,p 6 A. r-, S L-/-,.g Z-
cc
L- cr-7— Z- s -T PL-oc�:-T—
C) cr: A L- Z- 5 8
ui 1.q, 2--7+
-n
:13 m m
6F- L-0-r im rr
V-oof=m Z-3GO I " 4. t'rm Q rz--S
R 1>e-c-K-
10
C=
3 7 -1 t> Z: C=
Lu -3 Z, o 0 ---1 -L-
Z-50 C, m
t>jsro&r-- or- a
u -r I la F= -T- L- 0-r -ro 5-KrOSE-L-)
N4 Co F,6, L I W F—, v4," t- G C./i, rf-=.J� ell' ',t VI 0
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
'S C.
vv\
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
GasPiping .................
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 ..................
ftq
-0 7q&
Tile illitials MTare N/filtoll
nion,I)son,a tcmi)orary contract
inspector ror the city.
z
0
i
0
M
-n
M
M
0
__10
0 C
M
M Z
—Z
o -n
n�
MM
0 _0)
0
0 M
0)
0)
M 0
Z r-
;U
--I
M
z
--I
M
0)
z
0
--I
3
M