20040781.pdfW
DATE RECEIVED PERMIT EXPIRES 11 L L----
USE PERMIT
ZONE
CITY OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 3
570 7 &/rl
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
Cc MAILING ADDRESS LID FEE $
W
IESCP Approved 0
P BLI I LU.Qfjja.MB nEFlrIAl 'Pffftit Required [3
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0 _Q "Yf
2- &) Strool QSo Pennit Roq'd 0
CITY TELEPHONE E n Required [3
ZIP 1'S0bftfirz4"-r"1P_ft! IM"a Required 0
R QePgPEDIfA1 11 tied
#_I r 'it 1 quilod [3
01 1
24 67�,IZ q
NAME tT�E� SIZE LINE SIZE URES PrV REQUIRED
YES E3 NO 1:1
ui ul
t: ADDRESS z
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CITY ZIP TELEPHONE ion fuel-burningappliatices passing
I t1irough unheated spaces. IMC 803-f—
NAME #
16 ENGINEERING RU DATE
7h Z2�j /4(_ -e /q_ZL-eZj F I z
IPL
Cr ADDRESS
0 TEST MUST BE
IfII�FtG I UKTE
FIRE FIEVIMIP&
CITY TELEPHONE
0 egIZI.P. AFFIDAVITS SHALL NOT
us: - �e (17Ld
STATE LICI!NSE NUMBER I CHEC VARIANCE OR CU UtRANEPTA INSPECTION I 13OND
ION DATE jqD B REO'D POSTED
—/ / &;_ f OYES ONO Is
tL"�iqj/ loe 2� Lo) Z2 SEPA REVIEW SIGN ARE TE I HEIGHT
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PROPERTY TAX ACCOUNT PARC��O. COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
ul EXP
.;j --- 67 C'
NEW
RESIDENTIAL
11
ADDITION
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COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE. BUSINESS Oft -ACTIVITY) EXPLAIN
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
M
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
I
f
6f/
-2, _'�S
HEAT Squ CE GLAZING % LOT SLOPE %
1 7 1 1
CK NO: I VESTED DATE
LprcovMA6E----LlEaUtaLp.qETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLO FRINT §Mr--M7tT— R SIDE REAR
z
apdEfilfgh to t ie required
�1 a 113MIIIEWI! DATE
REfl'I"W"r " WAvARFAMMOVed
I E54ansion tank Shall be
0. A-11
FT) kRE h0t water tanks,
1rT*nei
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT I 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 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
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT 1HE 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 V;OLATION OF THE LA13OR CODE OF THE STATE OF WASIIINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 11127.
VIGN TURE (OWt R 611 AGENT) DATE S NED
, __4 1 - (? 7,7
A ( I - J I
CHECKED BY ITYPE,V r 1
�7 NrT Ral 10 N CO OCCUPANT
GROUP
SPECIAL INSPECTION [AtA OCCUPANT
REQUIRED LOAD
REMARKS z
PROGRESS INSPECTIONS PER USC 108/IBC1091IRCID9 FINAL INSPECTION REQ'D
I'UKSUANT TO UPC 605.2
A WATER SER ' VIGN 214UTgFr.
SHALL BE INSTALLED ON THE
VALUATION -T11 JuNFERSTHEBUILDING
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTI
(425)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # Z- I/ "Y 7 7
APPLICATION APPROVAL
This application is not a permit until signed by the
Building 011icial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
t GNATUR DATE
R
Sj
/Al-rENTION EXT 1 333-1-�.-t
IT IS UNLAWFULTO USE ORb//CCUPYA BUILDING OR STRUCTURE UN'TILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
By I DATE
ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
z
0
11
0
M
--i -n
M
C
M
0
--i (-)
0 C
M
M z
01
C _z
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In
M M
0
0
0 M
U)
0)
M
Z
M
z
z
0
1
0
M
"I
.. M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing .......................
Wall..........................
Pier/Porch .................
z
Retaining Wall ............ 0
Slab Insulation ........... 0
M
PLUMBING:
Underground .............
0 171
Rough -In .................... C
M 0
0
Commercial Final ...... 0
0
—4
HEATING: x M
M Z
Gas Test .................... o jo
C: z
Gas Piping . .................
Cn
Equipment .................
_n
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING .......................... Cn
0
FRAMING ......................... 0111TI
C Cn
9 Cn
FIRST FLOOR FRAMING... M 0
Z
.1
INSULATION, ............ I ......
Floor Insulation .........
>
Wall Insulation ........... z
--I
Ceiling Insulation .......
C/)
z
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ... 0
IT11
MISCELLANEOUS . ..........
FINAL APPROVAL FOR
OCCUPANCY .................. vv\3
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