20040823.pdfDATE RECEIVED
[PERMIT EXPIRES
Lj� -E T-1
JSE1 PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS
OWNER NAME/ AME OF BUSINESS 16170-7 kO,7Pv
5�etx Ae� 6 e( V I C, PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE $
LU
z TESCP APPrOvOd 13
T I q EC, 7N, Co PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
0 -72--7 RW Permit Required 0
Street Use Permit Roq'd El
CITY ZIP TELf PHONE EXISTING - PROPOSED inspection Required 13
<�, Sidewalk Required (3
cl I REQUIRED DEDICATION- IFT unck, rground
02 6�3 7 Wiring requited 13
NAME METER SIZE Ll"ZE NO. OF FIXTURES PRV REQUIRED
z
r YES NO
e%fto pinic 7-isk vritIlIST 8� LU
UJI �_U_ lidw z
I= ADDRESS REMARKS z
OWNER/C20MMIMtONEIEMR!t2MBEECI MIINAGE
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CITY ZIP TELEP14ONE A.EEID-AVITS SHALL NOT
BE ACCEPTED
NAME jCBL#
U)q �6 I I L ENGINEERING REVIEWED BY DATE
ADDRESS
0
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ZI TELEPHONE M
CITY "Malb F!wAirleal Permit
U 292'-f-70 .14
VAR ANCE OR CU sk6REIJIN1E f5f��dBwj_N�PECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE CHE Y POSTED
LO A9 g--<�- q -� t oi� I f11YES ONO S
U_�) SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PAFICEIL NO COMPLETE EXEMPT ALLOWED PROPOSED ALLOWED , PROPOSED
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0,0 Lj EXP
NEW &,RESIDENTIAL PLUMBING / MECH .. LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDE D LOT AREA 911.
REPAIR GRADING FENCE
CYDS ( X FT) REMARKS
DEMOLISH TANK Ei OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
� t (TYPE OF USE, BUS1,"ESS OR ACTIVITY) EXPLAIN:
Z7 I -
rj NUMBER
NUMBER OF
OF
DWELLING
0 STORIES
UNITS
DESCRIBE WORK TO
BE DONE
r
2�O
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
CRITICAL
AREAS
NUMBER
n
C) r
LOT SLOPE %
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.
ILI PERMIT APPUCATION: 180 DAYS
IL 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
2 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
.j DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
9 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRLIC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18,27.
SIGNATURE (OWNER q`R AGENT) I DATE SJPNED j i
I
CHECKED BY I TYPE F gCO.NSTRUCT CODE OCCUPANT
f'OL GROUP
� P -5
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [:] YES LOAD
REMARKS
z
PROGRESS INSPECTIONS PER UBC 108 / IBC109/ IRC109 FINAL INSPEC71ON RECI'D
VALUATION
Description FEE Description FEE
Plan Check State Surcharge
Building Permit City Surcharge
Plumbing Base Fee
0
Mechanical C2 0
Grading
Engr. Review
Engr. Inspection
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt P
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/her Deputy: and Fees are paid, and
FOR INSPECTION receipt is aAlnowlLdged in Space provided.
SVNAIL RE TE
(425)CVIr L
771-0220 -EASED BY AT
ATTENTION I EXT 1333
IT IS UNLAWFULTO USE OR OCC14YABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW . INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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11
0
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0
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71
X
X
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0
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0
171
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
z
Retaining Wall
Slab Insulation .......... 0
M
PLUMBING:
Underground ............. 6
M
Rough -In ................... C
M
0
Commercial Final ......
0 C
HEATING: X M
M Z
Gas Test ....................
C:
C/ >
Gas Piping .................
Equipment .................
-n
o
Commercial Final ....... n
EXTERIOR SHEATHING M M
NAILING .......................... 0 C/)
0 r-
0 M
FRAMING ........................ C C/)
C V)
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
Floor Insulation .........
3:
Wall Insulation ........... z
__l
Ceiling Insulation ..... x
U5
SHEETROCK NAILING ... z
0
--I
SPECIAL INSPECTION ... 0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR tZ—;Z,3— d
OCCUPANCY ..................
The Initials MT are Milton
Thompson, a temporary contract
inspector fbr tile City.