20040858.pdfI
DATE RECEIVED
PERMIT EXPIR S
USE PERMIT
CITY OF EDMONDS ZONE RITI NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITE/APT#
ADDRESS
OWNER NAME/NAME OF BUSINESS IC
Dpi\J LA uO )Ft Rvl/ I PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
M MAILING ADDRESS LID FEE S
W TESCP Approved
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
3: A�) street Use Permit Roq'd E3
0 Kko S inspection Required 0
CITY ZIP TELEPHONE EXISTING - PROPOSED Sidewalk Required
Underground
REQUIRED DEDICATION- FT Wiring required
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
0 z
YES 03 N 0 1:31 E
uj
ul z
ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE E5
z
L) ul
M
It
CITY ZIP TELEPHONE
)01 DATE
NAME _r
wvv NGINEERING REVIEWED BY
cc ADDRESS
0
FIRE REVIEWED BY DATE
!i CITY ZIP TELEPHONE
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER E DATE REO'D POSTED
0 � ot,tts I- Y 10YES ONO s
,Mi — �� -7 �_NAC) SEPA REVIEW SIGN AREA HEIGHT OSED
PROPERTY TAX ACCOUNT PARCEL NO. I COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED I PROP
4x
lu "?
nn (Doo C) z0b EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
VfL z
COMPLIANCE OR z
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
a.
El REMODEL MULTIFAMILY SIGN REO'D I PROVIDED
GRADING FENCE
REPAIR CYDS ( x FT) REMARKS
OTHER
DEMOLISH TANK
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTD1Ir
EXPLAIN: CHECKED BY TY U _GT_I 6 N OCCUPANT
GROUP
NUMBER OF CRITICAL
W NUMBER OCCUPANT
'3 OF DWELLING AREAS SPECIAL INSPECTION LOAD
M UNI Al. -I A- NUMBER REQUIRED
0 STORIES 7-,,.- 1 1 [] YES
BE IBE WORK TO BE IkONE
C�VW �� REMARKS z
PROGRESSINSPECTIONS PER UBC 108/IBC109/IRCID9 FINAL INSPECTION REQ'D
VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECK NO: 7 VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
I= 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: 180 DAYS
ul
CIL PERMIT LIMIT. 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
- U) 'APPLICANT. ON BE14ALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIF)� DEFEND AND HOLD HARMLESS THE CITY OF
M 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.
C1 DEEMED TO MODIFN� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE Total Amt. Due
01 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
x Receipt #
Recording Fee
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/tier Deputy: and Fees are paid, and
IN VIOLATION OF THE ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
LA
WORKMI�N'S COMPENSATI07N U�ANCE AND RCW 18.27.
OFFICIALS SIGNATURE
SI(N�.TtRE (OWNE "OR / WE:'-L, DATE SIGNED (425)
771 -0220 Asop T
R LE BY
EXT 1333,
ATTENTION "t-t ijtt, fl)
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL aj
INSPECTION HAS BEEN MADE AND APPROVAL OR A 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 COI IES
z
0
1
0
M
q =-n
M
M 0
0
C-)
0 C
M
M Z
x
Cl)
o -n
n ;u
>
M M
0
0
0 M
C cl)
9 [n
M 0
Z
7-1
z
Cl)
z
0
1
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
14. 4
tic
Commercial Final .......
L k
EXTERIOR SHEATHING
NAILING ..........................
FRAMING ........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
loie
Thc initi-ais wr are Miltol,
Thompson, a temporary contract
inspector for the City.
z
0
1
0
M
(J)
ITI
C
rn
0
0
0
M
M z
C
o -n
n
MITI
0
0 M
C (j)
M 0
Z
z
z
0
M