20040859.pdfI
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER�NAMEINAME OF WSINJESS
AL �, 0 f I ra ct
MA10&WADDHESS
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NAME
ADDRESS
CITY I ZIP I TELEPHONE
NAME .0
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CIT*& ZIP I TELEPHONE
STATE LICENSE NUMBER
SOT
T-T� , _., q 7
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
EiGARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN7
a
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NUMBER
OF
STORIES
NUMBEOF
DWELLING
UNITS
DESCRI13E WORK TO BE DONE -1%1% . . I I - A %��
(� ji . '-4 , ., c
:11
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( x FT)
OTHEVVI ft7
-f7 I -
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
I 11 Y-2,1 'Cj0\A R�-� -
ezigqEo
HEAT SOURCE GLAZING %
PLAN CHECK NO: ic)l 1, -�
.. I e, 47�
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.
PERMIT APPLICATION: 180 DAYS
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 INDEMNIFN� 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 HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.*
PERMITEXPIRES
USE PERMIT
ZONE NUMBER
JOB
SUITE/APT#
ADDRESS
,4
PLAT NAM E/SU BDIVI SION NO. LOT NO.
LID NO.
I
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved 13
RW Permit Required 13
street Use Permit Raq'd 0
EXISTING - PROPOSED
Inspection Required 13
Sidewalk Requited 0
REQUIRED DEDICATION- FT
Underground
Wiring required E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
I
PRV REQUIRED
I
YES13 NO 13
REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING R
FIRE REVIEWED BY
VARIANCE OR CU
SEPA REVIEW
COMPLETE , EXEMPT
EXP J�
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REO'D I PROVIDED
REMARKS
CHECKED BY ITYPE
DATE
DATE
'1R1,ELIN;E OR ADB# INSPECTION I BOND
POSTED
OYES IWO I S
HEIGHT
SIGN AREA
ALLOWED . PROPOSED r ALLOWED , PROPOSED
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REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR FRONT UR SIDE REAR
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LOT AREA I PLANNING REVIEWED BY DATE
SPECIAL INSPECTION JAREA
REQUIRED C:
OCCUPAN�
GROUP
OCCUPANf
LOAD
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REMARKS L
PROGRESS INSPECTIONS PER UBC 108 JIBC109 / IRC109 FINAL INSPECTION REQ'D A
VALUATION
$ �56 0
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge_
Base Fee
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 CONSTRUC- CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE ODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
"ON
' 0 F
'UC _
I D
�JYE
To
LABefiNSCRANCE AND RCW 18.27.
WORKMEWS COMPENSAW
SIGNP
.�TURE (OWVNE OR VqEJ4�,�,
(4251
ILI
DATE SIGNED
771-0220
ATTENTION E)ff 133r
IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCLI-
PANCY HAS BEEN GRANTED. UBC109/lBC110/lRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 CO
Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt #
1,;?
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FFICIA�S SIGNA 1� URE PATE
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ORIGINAL -FILE YELL(YVVIINSPECTC
PINK - OWNER GOLD - ASSESSOR
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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 .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING..........................
FRAMING........................
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR Jt�
OCCUPANCY ..................
aw 215747
Thc initials MT are Milto"
Thompson, a tertworary contract
inspector for the CitY.
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