20040853.pdfDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
Dennis Lydston
MAILING ADDRESS
17003 72 P1 W
CITY
ZIP TELEPHONE
Edmonds 9 1425-787-3456
NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME ICBL
ADDRESS
12601 132 Ave NE
CITY ZIP TELEPHONE
Kirkland 98034 1425-814-3124
STATE LICENSE NUMBER EXPIRATION DATE CHECKFP B(
FASTWHCO52DF 2-16-05
PROPERTY TAX ACCOUNT PARCEL NO.
00741700000300
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING
CYDS
DEMOLISH
TANK
GARAGE
rARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSIV-Sy OR ACTWITY) EXLLAIN:
NUMBER NUMBER OF
OF DWELLING
M
0 STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE
PLAN CHECK NO:
PLUMBING / MECH
El
COMPLIANCE OR
CHANGE OF USE
SIGN
ElFENCE
x FT)
El
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
00 btu's
GLAZING %
P ERMIT EXPIRES
USE PERMIT
ZONE NUMBER
JOB
ADDRESS
17003 72 P1 W
PLAT NAME/SUBDIVISION NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION� FT
METER SIZE LINE SIZE NO. OF FIXTURES
REMARKS
PPI
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED 13Y ITYPE
an appit,
$n ta�,).k shall be
I
n all hot water tan
SHORELINE OR ADBN
SUITEIAPT#
LID NO.
LID FEE $
TESCP Approved
RW Permit Required
Street Use Permit Roq'd
inspection Required
Sidewalk Required
undertiround
Winna required
PRV REQUIRED
YES 13 NO 13
DA
DATE
INSPECTION
REO'D
OYES ONO IS
SIGN AREA 1-
ALLOWED . PROPOSED I ALLOWED
BOND
POSTED
HT
PROPOSED
REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT LJR SIDE REAR
LOT AREA PLANNING REVIEWED BY
SPECIAL INSPECTION JAREA
REQUIRED [] YES
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
Z
Cr.
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r IREMARKS
S INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REO'D oz—
PROGRES 9
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 PU13LIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
PERMIT LIMIT. 1 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 10 ENFORCE ANY ORDINANCE PROVISION."
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT T14E 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
SIGNATURE (9 tjER AGEN DATE SIGNED
Kf 16,
VALUATION
$
4 -1
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPEI
(42
5)
771-0220
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt # I
APPLICATION APPRI�
This application is not a pernlit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
- I / I
-F
7 SIGNYATE ATE
11 j
91 M _, /09
A17ENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
D BY DA
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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0
M
0
0 M
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0
11 0
0 C::
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0
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0
0
IT!
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9 Cn
M 0
Z
X
>
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(n
z
0
I
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Fboting . ......................
..Wall ..............................
Pier/Porch .................
z
0
Retaining Wall ...........
-1
Slab Insulation ..........
Ri
PLUMBING:
Underground .............
0 M
C
ITI
Rough -In ...................
0
__10
0
Commercial Final ......
C
M
HEATING:
M Z
Gas Test ....................
C
> z
r— --I
Gas piping .................
x
Equipmeht .................
0 -n
Commercial Final .......
M M
EXTERIOR SHEATHING
0
0
NAILING ..........................
0 M
C CD
FRAMING ........................
9 Cn
Q 0
FIRST FLOOR FRAMING ...
Z
-A
INSULATION ...................
Floor Insulation .........
>
z
Wall insulation ...........
---I
Ceiling Insulation .......
0)
z
SHEETROCK NAILING ...
0
0
SPECIAL INSPECTION ...
171
e ID -5
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials POTare Miltoll
1,110111I)s011, a tel"porary contract
illSI)eCtOl. rol. tile City,