20040866.pdfV ,
DATE RECEIVED
MI-)LI __1 FP ERMIT EXPIRES
USE PERMIT
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C1W OF EDMONDS NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/NAME OF 13USINESS _44 t tj
A I I I I PLA1 NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required E3
30: On ON,, r)10 Street Use Permit Roq'd [3
CITY 71P [TELEPHONE EXISTING — PROPOSED Inspection Requited 0
Sidewalk Requited E3
REQUIRED DEDICATION— FT Underground
Wiringfoquired 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
YES 13 NO 13 3
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REMARKS z
U OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE a
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CITY ZIP ITELEPHONE
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FIRE REVIEWED BY DATE W
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CITY ZIP TELEPHONE rL_
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U K Y, L-j- VARIANCE OR CU SHORELINE ADB INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION DATE 6KD BY ot 9b REQ�Df POSTED
I!A OYES
Oc�W if3 SEPA REVIEW SIGWA'REA JKNO S HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALL,$KV , PROPOSED
W ,<, I q -tiot 7 4 /'Ui.+
010 7-700 EXP 17
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LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FT.)
NEW 11 RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT L/R SIDE REAR
--------------
COMPLIANCE OR ---------- z
ADDITION COMMERCIAL z
11 CHANGE OF USE z
PARKING LOT AREA IVEJ) BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D I PROVIDED G AEVIEJ CL
REPAIR GRADING FENCE
CYDS ( x FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
E (TYPE OF USE, 13USINPSS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE OF CON ICTION CODE OCCUPANT
GROUP
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tu NUMBER NUMB&OF CRITICAL
OF 7DWIELLING AREAS R SPECIAL INSPECTION JAREA OCCUPANT
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NUMBE
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AjC, REMARKS
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PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REQ'j F3
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VALUATION
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Description FEE Description
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE %
Building Permit C� City Surcharge
PLAN CHECK 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
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
Engr. Review
Lu PERMIT APPLICATION: 160 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST. AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHAI EVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENTOF ANY CITY ORDINANCE
X0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
1 1 1 � /Z�7
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 APPLICATION APPROVAL
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 LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
_41a OFF�C ALS SIGN TURE DATE
WNER OR(Aq1F DATE SIGNED 5) yx
SIGNATURE (0 �ND' (42!
RELEtSED By
771 -02-20 DXTE
333
E)ff 1
A17ENTION
ITIS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE - YELLOW - INSWICTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER - GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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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 -7- o
OCCUPANCY ..................
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