20040765.pdfIII
co
USE
CITY OF EDMONDS ZONE
JOB
CONSTRUCTION PERMIT APPLICATION ADDRESS 1,.
OWNER NAME/NAME OF BUSINESS
PLAT NAME/SUBDIVISION NO
V� tn V< P v— �_A q11
M
MAILING ADDRESS
W
z
0
CITY
NAME
IA-
't-I ADDRES
CITY
NAME
ADDRESS
STATE LICENSE NUMBER
U EG N-C P.,
�ROPERTY TAX ACCOUNT
L
f V Y' � � I
ZIP TELEPHONE
9- � At) Lq 1_% r- - (il �
LA.�K OU 3-
ZIP
ZIP
CEL NO.
TELEPHONE
CBLI/
VA ot
V6 6"�, V� I t (Qcj
TELEPHONE
4ois- &�'_ (POU
EXPIRATION DATE CHECKED,8'i
NEW
17f__-U ESIDENTIAL
PLUMBING / MECH
ADDITION
F-1
COMMERCIAL
El
COMPLIANCE OR
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
REPAIR
GRADING
CYDS
FENCE
( X FT)
DEMOLISH
TANK
E rVjp
GARAGE
CARPORT
RETAINING WALL
ROCKERY
El
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN
WCP Xwoc)_Ir_
NUMBER
NUMBER OF
CRITICAL
w
0
OF
DWELLING
I I
AREAS
to
0 STORIES
UNITS
NUMBER
DESCRIBE WORK TO BE DONE
-.40 C11-Y � f'*N CA M
I Y'\A tor'\ OLLS -
HEAT SOU�CE GLAZYG % LOT SLOPE %
PLAN CHECK NO: VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS. SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTUY On INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOI BE
DEEMED 10 MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION
I
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT: AND THAT I AM THE OWNER, OR THE DUC� 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 V;6LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (OWNER OR(,�GE DATE SIGNED
/Y I / I __% 19 , lo — 0
PERMITEXPIRES
PERMIT
NUMBER
SUITE/APT#
7 OT NO, LID NO,
LID FEE $
TESCP App(ov0d 13
PUBLIC RIGIIT OF WAY PER OFFICIAL STREET MAP
Rw Permit Required
E3
Street Use Permit Roq'd
13
EXISTING __ PROPOSED
Inspection Required
13
Sidewalk Required
E3
11EQUIRED DEDICATION— FT
underground
WinnU required
0
METER SIZE
NO. OF FIXTURES
PRV REQUIRED
17
YES 13 NO
1
cc
Lu
REMARKS
z
z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
33
z
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE W
VARIANCE OR CU
SHORELINE OR ADBtf
INSPECTION
BOND
I
REO'D
POSTED
OYES ONO
S
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP
,
I -
LOT COVERAGE
REQUIRED SETBACKS (FT)
PROPOSED SETBACKS (Frf)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
z
z
PARKING
I
LOT AREA
PLANNING REVIEWED BY DATE
I
REO'D I PROVIDED
REMARKS
CHECKED BY
OCCUPANT
GROUP
SPECIAL INSPECTION JAREA UL;I-;ur8N I
REQUIRED LOAD
REMARKS z
PROGRESS INSPECTIONS PER LIBC 108/FINAL INSPECTION REG-D
n �. f 1�) J
Description FEE Description FEE
Plan Check
State Surcharge
Building Permit
City Surcharge
7�?
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapelnsp.
Total Amt. Due
D
Recording Fee
Receipt #
APPLICATION APPROVAL
CALL
I his application is not a permit until signed by the
Building Oificial or histhei Deputy. and FOOS are paid. and
FOR INSPECTION
iLceipt is acknowledged in space provided
F CI LS SIGNA HE
(425)
771-0220
R
[.EASED BY
ATTENTJON A I I
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
04,02 PRESS HARD -YOU ARE MAKING 5 COPIES
ORIGINAL - FILE YELLOW . INSPECTOR
PINK - OWNER GOLD ASSESSOR
GREEN ACCOUNTING
z
0
1
0
M
--i -n
U5 --j
3:
0 M
C
M 0
0
C)
0 C:
--I K
3: M
M Z
10--1
C
3:
(1)
0 71
n
--I
3:9
M M
0 Fn
0 r-
0 M
C/)
M
Z
X
z
__I
3:
U)
z
0
A
0
1711
I
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 ..................
The Initials MT are Milton
Thompson,a tcniporary contract
Inspector for the City.
z
0
4
0
M
—i -n
M
C
M 0
0
C)
0 C:
M
M Z
_Z
cn
0 _n
n
M M
0
0
0 M
Cj)
Cl)
ITI C)
Z
71
z
—4
:C
Cn
z
0
1
0
171