20040820.pdfDATE RECEIVED
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USE PERMIT
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CITY OF EDMONDS
JOB SUITEIAPT#
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CONSTRUCTION PERMIT APPLICATION ADDRESS (5 A
OWNER NAME/NAME X BUSINESS iltL
PI AT NAMEISUBDIVISION NO LOT fiO. LID NO.
MAILING ADDRESS LID FEE $
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z TESCP Approved 13
0 PUBLIC RIGIIT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
1 Street use Permit Roct-11 13
CITY EXISTING — PROPOSED Inspecticri Required [3
,IP TEIEPHONE Sidewalk Required E3
REQUIRFI) DEDICATION— F1 Undayground
tAA?,o Wiring required E3
NAME METER SIZE NO� OF FIXTURES PRV REQUIRED
A LI-- v 6-0 C-S YES13 NO IJ z
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t: ADDRESS REMARKS z
OWNERICONTRAClOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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CITY ZIP TTELEPHONE Otilt t-j --a— S
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C N G� rIN EKE R gIN GOR E ED I DATE
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M `9`6S 707" FIRE REVIEWED BY DATE W
ITY zi TEI EP NE M
0 M
C� D N cl �kij Al VARIANCE OR Cu SHORELINE OR ADBO INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE REQ*D POSTED
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RA PE /\/ `1 V �. 7 11_Q) , U0,0It5-,,\kIYES ONO IS
Q sJo SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO, COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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PLUMBING MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW F RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL f
CHANGE OF USE z
PARKING LOT AREA PLAVULNG REVIEWED BY DATE
REMODEL MULTIFAMILY SIGN VIDED
GRADING FENCE 747
REPAIR CYDS ( x FT) REMARKS
F-1 DEMOLISH E] TANK OTHER
o GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT 13 ROCKERY FIRE ALARM
I (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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U) S/O/V I co.747
tu NUMBER NUMBER OF CRITICAL
a OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
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to STORIES UNITS NUMBER AA REQUIRED [I YES LOAD
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D FS
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4. VALUATION
V $
Description FEE Description FEE
.114,4
Plan Check .1'n State Surcharge
URCE GLAZING % LOT SLOPE %
Building Permit City Sur harge
CK NO: 0 VESTED DATE Plumbing Base Fee
Mechanical
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 Grading
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 1180 DAYS
PERMIT LIMITII YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
0 / 11)
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fi: Inspection Receipt #
Cc ALI. CLAIMS FOR DAMAGES OF WHATEVER NA1 URE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE
a DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
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0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
MI Recording Fee Receipt N
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 WITII 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 Official of his/tier Depuly� and Fees are paid. and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASIIING10N RELATING TO FOR INSPECTION receipt is acknowledged in space provided
WORKMEN'S COMP RANCE AND RCW 18 27. 0011AIALS S NATURE DATE
SIG ATURE (OWNER OR ENT) DATE SIGNED
(425)
771-0220 HEI. SED BY DATE
ATTENTIO C-111-Y
IT IS UNLAWFUL USE - OR OCCUPY B ILDING OR S UR , E UNTIL EXT 1333
A FINAL INSPECTIO * HAS-BEFENMAD AND APPROVAL OR A CERTIFI-
ORIGINAL RLE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OVvNER GOLD - ASSESSOR
OgI03 PRESS HARD -YOU ARiZMAKIING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
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Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ................... M
C
M
0
Commercial Final ...... C)
0
HEATING:
M
M z
GasTest ....................
C z
Gas Piping ................. > --I
3:
Equipment .................
0 -n
Commercial Final .......
EXTERIOR SHEATHING
MITI
NAILING..........................
0
FRAMING ........................ 0 M
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FIRST FLOOR FRAMING ...
M 0,
Z
INSULATION ................... 7-1
Floor Insulation .........
Wall Insulation ........... z
Ceiling Insulation ....... :E
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SHEETROCK NAILING ... z
0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
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