20040789.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS
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Lynnwood Horda
M MAILING ADDRESS
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ZIP TELEPHONE
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NAME
Bum�,-ardner
Aricaitecture
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ADDRESS
2 1- 11 T'.-, i r d
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CITY
ZIP
L)eattle
98 121
ITELEPHONE
_J0 4.3-13
NAME
State Hecha-rqical Co
9;1
ADDRESS
600 TjjdUStry Dr #8
CITY
ZIP
TELEPHONE
'rulkwila
98i83
206-575-7327
STATE LICENSE NUMBER
EXPIRATION DATE
CHECKI
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PROPERTY TAX ACCOUNT PARCEL NO. '27042900303700
��704290030")900/'2704290030-)4100
[:] NEW
RESIDENTIAL
PLUM13ING / MECH
E] ADDITION
COMMERCIAL
COMPLIANCE OR
CHANGE OF USE
ED REMODEL
APARTMENT
SIGN
GRADING
FENCE
PERMIT EXPIRES
USE PERMIT
ZONE
NUMBER,.
JOB SUITE/API #
ADDRESS 9-2020 Higyhway 99
PLAT NAME/S U B DIVISION NO. LOT NO.. LID NO.
LID FEE S
TESCP Approved C3
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
Rw Parinit Required 13
Street Use Pomit Roq'd 13
EXISTING - PROPOSED
inspection Required 13
Sidewalk Required E3
REQUIRED DEDICATION- FT
Underground
Winng required 13
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
I z4
YES NO 19,/ zo
Fr
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REMARKS z
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 5
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ENGINEERING REVIEWED/DATE
FIRE REVIEWED BY DATE ul
F' RE EV 'Ew E D
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IA NCE 0 R
VARIANCE OR CU
VAR
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SHORELINE OR ADB#
INSPECTION
13OND
BY
REO'D
POSTED
[3YES [:] NO
SEPA REVIEW
S E PA REVI E)
tEXP
SIGN AREA
HEIGHT
PL X1
COMPLETE EXEMPT
OM
ALLOWED PROPOSED
ALLOWED PROPOSED
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
ALLOWED PRO POSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
I PLANNING REVIEWED By DATE IL
5
REQ'D I PROVIDED
Lj REPAIR 1-i CYDS x Fr) REMARKS
F] DEMOLISH TANK
E] OTHER
EiGARAGE RETAINING WALL
RENEWAL
I
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
Autoiobile dealer
NUMBER
NUMBER OF
CF3111CAL
OF
DWELLING
AREAS
STORIES
UNITS
NUMBER
k 1 DESCRIBE WbRK TO 13E DONE
J_ _-
Hxt-ures
CHECKED BY
SPECIAL INSPECTOF
REQUIRED [:] YES
GROUP4
_'.4
OCCUPA
LOAD �
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION RECI'D
A
a53
VALUATION $
FEE
n I FEE
Plan Check
HEAT SOURCE GLAZING % LOT SLOPE % Building
PLAN CHECM:'� VESTED DATE Plumbing
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 Grading Recording Fee
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC,1 WILL REQUIRE
SEPARATE PERMISSION. Engr. Review City Surcharge
Lu PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr.Inspection State Surcharge
SEE BACK OF PINK PERMIT FOR MORE INFORMATION Traffic Mitigation Plan Chk Deposit
'APPLICANT ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE UIIY Ut-
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Review Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF IHIS PERMIT SHALL NOT HE Fire Inspection Total Amount Due
a 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.,
xi - Landscapelnsp. Receipt #
1 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 This application is not a permit until signed by the
THE OWNE�� To COMPLY WITH CITY AND STATE L.AWS REGULATING CONSTRUC- CALL and Fees are paid, and
TION; AIN DING T tIE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Olficial or hisitier Deputy:,
IN VIOL N FORINSPEC receipt is acknowledged in space provided,
rlo� OF TION
,),tTlIE, LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
INS
ENSfATION I URANCE AND RCW 1B.27. OFFICIA S� PIG NATURE DATE
SIGNAT W ER GENT) DATE SIGNED (425)
771-0220 RF�EIASFD BY DATE
A#ENTION EXT 1333
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL 4-1)1
CTOR
771-0221 4
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- '6HIGINAL - FILE - YELLOW - INSW'ToR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 FAX PINK - OWNER - GOLD - ASSESSOR
10/01
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -in tAAJ :d�i_clel - - _C,
...................
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 ..................
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