20040824.pdf[DATE RECEIVED 7PERMIT EXPIRES
UIE PERMIT
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CITY OF EDMONDS NUMBER
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CONSTRUCTION PERMIT APPLICATION ADDRESS!ZjgcDe q �r? /, �)
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OWNER NAME/NAME OF BUSINESS
PLAT NAM E/S UBDIVI SION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
W -A �13
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP Rvir Permit Required E3
70 P615— P - Street Use Pomnit Roq'd
CITY HONE EXISTING � PROPOSED-- inspection Required
ZIP ITELE Sidewalk Required [3
Underground
REQUIRED DEDICATION— Fr Winng required 0
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NAME METER SIZE in PRV REQUIRED 0
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STATE LICENSE NUMBER EXPIRATION DATE RHECKED pla� ��q'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO. It o OVA PROPOSED
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NEW RESIDENTIAL PLUMBING MECH WSW #.ftu flt%IW):fTWeCjrEtftn RONT LJR SIDE REAR
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GRADING FENCE
REPAIR CYDS 1:1 ( X FT) 1E
DEMOLISH TANK El OTHER SfZ2tC- 'oA&-Austries
GARAGE RETAININGWALL FIRE SPRINKLER
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E (TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED 13Y 0 TRUGF107""""" TcODE OCCUPANT
]TYPE 0 M2)T GROUP
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W NUMBER NUMBER OF CRITICA� ]AREA OCCUPANT
a OF DWELLIN AREAS SPECIAL INSPECTION LOAD
M I UNITS NUMBER REQUIRED [] YES
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DESCRIBE WORK TO BE DONE
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPEC . TION REO'D
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(Ikx4w, bil q -0 $
71) i IVA A) olev-a �i LTb O'k) E Description FEE
Plan Check State Surcharge
14 Y c4 Init 5 1 1
-SOURCE GLAIINd k LOT SLOPE % Building Permit City Surcharge
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PLAN ItHIECK NO: VESTED DATE Plumbing Base Fee
M chanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS. MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
2 Engr. Review
PERMIT APPLICATION: 180 DAYS
W
CL PERMIT LIMIT: I 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
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL. NOT BE
IREMENT OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REOU
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I 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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or his/her Deputy: and Fees are paid, and
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is ackno,)�Iedged in space - provided.
WORKMEN'S COM PEN SAT19V-14I&I.11:1�1NI CE AND RCW 18.27. FFICA SIGNATURE PD
SIGVATURE (OWPE!,OR �NT) or GNED (425)
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771-0220 R(L lliSED BY_
ATTENTION EXT 1*0333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALORA CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..............
FOUNDATION:
Footing ....................... .
........... ...
Pier/Porch ..... ............
-----------
Retaining Wall ...........
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0
Slab Insulation ..........
PLUMBING:
Underground ............. ----------
Rough-In ...................
0 M
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Commercial Final ......
M 0
HEATING: OC
1711 Gas Test ..... .............
M z
ID
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Gas Piping ................. C
> z
Equipment.................
Commercial Final .......
EXTERIOR SHEATHING
NAILING ..........................
M M
FRAMING ........................
0
0 M
FIRST FLOOR FRAMING ... C/)
C/)
M 0
INSULATION ................... Z
--I
Floor Insulation .........
Wall Insulation ........... x
Ceiling Insulation ....... z
---1
SHEETROCK NAILING ...
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SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................