20040857.pdf', DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEMAME OF BUSINESS *
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MAILING ADDRESS
CITY
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NAME
ADDRESS
CITY
NAME
ADDRESS
CITY
STATE LICENSE NUMBER
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PROPERTY TAX ACCOUN
ZIP
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ZIP
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TELEPHONE
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TELEPHONE
NEW
1:1 RESIDENTIAL
ADDITION
)4.COMMERCIAL
REMODEL
El
MULTIFAMILY
F1
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
P .--%
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L U 1-1 1 1 PERMIT EXPIRES
SIE PERMIT
ZONE NUMBER
JOB 1-z
ADDRESS Z
PLAT NAME/SUBDIVISION NO. I LOT NO
PUBLIC RIGHTOF WAY PER OFFICIAL STREET MAP
EXISTING - PROPOSED
REQUIRED DEDICATION- FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
LID NO.
LID FEE $
TIESCP Approved
RW perrout Required
Street Use Permit Floq'a
Inspection Required
Sidewalk Required
underground
Wiring required
PRV REQUIRED
YES 0 NO 13
REMARKS
OWNER/CONIRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
11 Lt -)b ENGINEERING REVIEWED BY
=FIREREVIEWED BY
DATETCUe=-CL BY
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
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FIRE SPRINKLER
FIRE ALARM
VARIANCE OR CU
SEPA REVIEW
COMPLETE EXEMPT
EXP I
LOT COVERAGE
ALLOWED PROPOSED
DATE
DATE
SHORELINE OR ADS# INSPECTION BOND
REQ'D POSTED
OYES ONO
IGWAREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
0
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5
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT)
FRONT SIDE REAR FRONT LJR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVIDE
REMARKS
CHECKEDBY JTYPf,�FCO TRUG)TIr E
Alp, COD
CRITICAL
AREAS SPECIAL INSPECTION JAREA
NUMBER 041C REQUIRED [] Y
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC1(
% . "h - ra 0 .� �- It 1 4/1 �' 11
I 1\)o t"h ck-lqc/4 6r) a.t) I rw- I
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
LOT SLOPE %
VESTED DATE
VALUATION
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Description
Plan Check
Building Permit_
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
PERMIT ILIMITI YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
FEE
OCCUPANT
GROUP
OCCUPANT
LOAD
FINALINSPECTION
Description I FEE
State Surcharge
City Surcharge
Base Fee r
11W
A 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
A
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
x FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapeinsp. Total Amt. Due
a —
DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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
Building Official or his/her Deputy: and Fees are paid, and
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a pernnit until signed by the
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 OR INSPECTION, receipt is acknowledged in space provided.
WORKMEN'S COMPENSATIotj RANCE AND RCW 18.2T
\OFFICIALS,SIGN Tu D TE
%
SjpVURE (OWNER DATE SIGNED (425)
ARGM)�
771-0220 LEASED BY DAT
7T'TENYION B9 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FIN
INSPECTION HAS BEEN MADE AND APPROVAL ORA 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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'By order of the Building Official for the
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Cit' of Ed' onds
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All persons Are Ordered to
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STOP.W
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Owner (if-kn6wn):
dAY
if know.n):. W
ontractor
'Me' e unable to, locate a valid permit T61* the.w6rk being doneat-:
ar
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%�'J§ requir . ed for this project. Work SHALL NOT continue,until a�perrni, j eep,:0_1 �ined
;-or inanc .. .-you"
�d nd� X1 es, Jf
insp cted for; es Ji
an� iliew'ork e
ad y obtained the I)cnnit,,I)Icasc contact its at'
1 :pernu
have a
Ire (4�5) ,7j,'9220.wit
i iber so we can revise our records.
ed or a response..io �wq ing�
An -application must be submitt t*
m
I terAhan 4:00 0 on,
mt1st,be made to our office no a
'A VIOLAT
]ON FEEEQUAL OR UP TOYIVE'TIME
FEE SHALL BE.ASSESStD-1--`.
THE PERMIT,
-Posted'tliis ay o
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0,
-'0 ffi
BL1i1dihg icial.
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."Warning: The failure'to stop this work or,activ fidh I
rem
e,,,,,, ovid,
permission or
resumin of -work -without
M able' e
01' Co C
ealment of this Notice is puni§fi- -byfilf,
utilation
gad.imprisonmen
City ol'Ednionds Development Services Department Building Divisi6n
RK
121 5"' Ave N 1�(Jnionds, WA 98020 (425) 771-0220
01'fice 11ours NI-F9-12 and 1-4
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch ................. z
0
Retaining Wall ........... --I
0
Slab Insulation .......... 1711
PLUMBING:
Underground .............
M
C
MRough -In ...................
0
0
Commercial Final ...... 0 C
--j K
M
HEATING: M Z
Gas Test .................... C
> z
-4
Gas Piping .................
Equipment ................. 0 -n t
-n
Commercial Final ....... -4
x
IT11 ITI
EXTERIOR SHEATHING a - I
Cn
NAILING .......................... 0 r-
0 M
C cf)
FRAMING ........................ C
Q 0
FIRST FLOOR FRAMING ... Z r-
INSULATION ................... ;U
--I
Floor Insulation .........
>
z
Wall Insulation ........... --I
Ceiling Insulation ....... Cn
z
SHEETROCK NAILING ... 0
I
SPECIAL INSPECTION ...
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
7 v000