20040865.pdfI DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF 13USINESS
- TE: P, P, � 3,C) 4 I'q
MAILING ADDRESS
-2 -2,12-
CITY ZIP TELE HONE
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NAME
ADDRESS
CITY ZIP I TELEPHONE
NAME CBL#
st,TT-k me�
ADDRESS
4415 V/00biNi)ILL4F_-RE-ZDMDf*N1b 'F0
01)zVO4 I I PERMIT EXPIRES
USE PERMIT
ZONE -�*?r/y /_
CITY ZIP I TELEPHONE
WooptNvjL_Lz-- 99072-147-549(o-cf2-&
STATE LICENSE NUMBER EXPIRATION DATE CHE D BY
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PROPERTY TAX ACCOUNT PARCEL
NO.
005�442-007,00'7
00
13 NEW
a
RESIDENTIAL
ADDITION
El
COMMERCIAL
REMODEL
A
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
nAPPnRT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
u
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w NUMBER NUMBER OF
a OF DWELLING
W UNITS
0 STORIES
DESCRIBE WORK TIBE DONE
. . P_ .11 - -1. .- _ . ..
r
/V(:3 DIV
14
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
2 PLUMBING / MECH
COMPLIANCE OR
11 CHANGE OF USE
13 SIGN
FENCE
1:1 ( x FT�
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
5fa,
n17 I
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 APPLIcA:rION: 180 DAYS
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 TO ENFORCE ANY ORDINANCE PROVISION. -
N U FVJ 0 r- M
JOB
ADDRESS 2,2-
PLAT NAME/SUBDIVISION NO. LOT NO,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION. FT
METER SIZE I LINE SIZE I NO. OF FIXTURES
REMARKS
OWN iiQln"I"TRA"'
In addition to the required
pressure/reri—ef Valve) an af
UPC 608
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SUITE/APT#
[f W
ID NO.
LID FEE: $
TESCP ApprOV07—
0
E3
RW Permit Required
13
Street USA permit Req'd
Inspection Required
[3
Sidewalk Required
E3
Undofground
[3
Winng requited
PRV REQUIRED
YES 0 NO 13
FIRE REVIEWED BY DATE
.......................... !07N D
VARIANCE OR CU SHORELINE OR A Isibet"IlUN
C �:' `5 'j
�REQ D POSTED
0 �L 8
S N
CIY�E N-0.
SI HEIGHT
EVIEW SIGN Ai
�mmjl EA PROPOSED
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REQUIRED SETBACKS (FF.
) SETBACKS (FT.)
UR SIDE REAR
[PARKING LOT AREA PLANNING REVIEWED BY DATE
R
E O'D I P R &VVA �PE Ili T NJUST BE A
REMARKOinil2r.1311 Prit nV f-'ITY INSFEC I Q R
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-
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.
I DATE SIGNED
SIGNATPRE (OWNER PR j��
I "--W1A11A,1Y1Y,4,0 /0 -/ 01 te)
CHECKED BY ITYPE
SPECIAL INSPECTION JAREA
REQUIRED E] YES I
OCCUPANT
GROUP
OCCUPANT
LOAD
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REMARKS 09FINALINSPEC-nON REQ'D
1PROGRESS INSPECTIONS PER UBC108/lBC11091IRC1
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
ILandscapeinsp.
FRecording Fee
CALL
FOR INSPEI
(425) (,
771-0220
.4010302
FEE Description FEE
State Surcharge
City Surcharge
3ase Fee
Plan Chk. Deposit
EfReceipt #
I
Total Amt. Due
Receipt
APPLICATION APPROVAL
I his application is not a pernfil until signed by the
Building Otticial or his/her Deputy: and Fees are paid, and
receipt is acknowledged in zipace provided.
FFI7C1',LS SIGNAT )RE D TE
A I / (.t"'( ) r
Vj J/
ATTENTION URE UNTILAFINAL
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCT
INSPECTION HAS BEEN MADE ANDAPPROVALOR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/lBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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ORIGINAL - FILE YELLOW - INSPECTOR
PINK - OWNER GOLD - ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulati.og . ........... i
Underground-; ...
Rough -In ...................
HEATING:;'
Gas Test ....................
7'
Gas Piping ................. Z
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
M r
OCCUPANCY ..................
The initials MT are Milton
Thompson, l temporary contract
inspector flor tile City,
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