20040867.pdfa
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
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OWNER NAME/NAME OF BUSINESS ION
11AA tJ CA,^/ kA
MAILING ADDRESS 43
2.,i011 AVEL-'
CITY ZIP ELEPHONE
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ADDRESS
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CITY ZIP ITEtEPII6E\
NAME
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IF I.I/
CITY ZIP
Dee I
STATE LICENSE NUMBER
212:
PROPERTY TAX ACCOUN'
NEW
ADDITION
ODEL
REPAIR
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DEMOLISH
GARAGE
CARPORT
(TYPE OF USE,
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PARCEL NO.
RESIDENTIAL
COMMERCIAL
MULTIFAMILY
TELEPHONE
7 (.-> � 3 ?�j S 7 � 'L-
GRADING CYOS
TANK
RETAINING WALL
ROCKERY
OR.ACTIVITY) EXPLAIN
NUMBER NUMBER 0
OF I DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
- Do Mry f . � -I-&
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
Fr)
( X
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
MUS170"Na
[PERMITEXPIRES
USE PERMIT
ZONE
NUMBER
JOB
ADDRESS,2.,, to
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SUITE/A�T#
Mt. 1, -
9s C) QS 2.
PLAT NAME/SUBDIVISION NO. LOT NO.
LID NO.
LID FEE $
PUBLIC RI,13HT OF WAY PER OFFICIAL STREET MAP
TESCP Ap iroved
Rw Permit Required
E3
Q
Street Use Permit Rnq'd
E3
EXISTING - PROPOSED
inspection Required
Sidewalk Required
[3
E3
REQUIRED DEDICATION- FT -
Underground
Winng required
E3
METER SIZE
LINE SIZE
NO. OF FIXTURES
PRV REQUIRED
YES NO 13
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU
ELNE OF' A B
SHORELINE OR ADB#
R o #L
ON
INSPECTION
IN SPEC
BC
Q�'
O'D
PBOND
OSTED
P 0
0YE VW
OYES
S
SEPA REVIEW
SIGN AREA
SIGN AREA
HEIGHT
HE IGHT
COMPLETE EXEMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
L L WED P R
0
EXP
LOT COVERAGE
REQUIRED SETBACKS (FT)
ETB�
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT LJR SIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED 13Y DATE
REO'D I PROVIDED
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REMARKS
CHECKED BY I TYPE OF
CODE OCCUPANT
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VS SPECIAL INSPECTION JAREA uu�urn
P' LOAD
REQUIRED C] YES
FREMARKS
P (
PROGRESS INSPEC*nONS PER UBC 108/ IBC109 I IRC109 FINAL INSPECTION REO'D
/7-. A�,o ir 4 1 A Jd� Aj
IF
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HEAT SOURCE
GLAZING %
LLOT SLOPE %
PLAN CHECK NO:
VESTED DATE
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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.
W
PERMIT APPLICATION: 180 DAYS
IL
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
2
EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE. ARISING DIRECILYORINDIRECItY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMI1 SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION,*
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTIIORIZED AGENT OF
THE OWNER. I AGREE TO COMPLY WITI I CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPIE�SATION INSURANCE AND RCW 18.27.
SIGNATURE
DATE SIGNED
/ALUATION
�E el.
Description
:)Ian Check
I
19"t
FEE Description FE
7
State Surcharge �z -
3uilding Permit
City Surcharge_
Plumbing
Base Fee
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Plan Chk. Deposit
Fire Inspection
Receipt #
Landscapeinsp.
Total Amt. Due
Recording Fee
Receipt #
(,q
CALL
FOR INSPECTION
C%
(425)
771-0220
APP�ICATION APPROVAL
This applicationis not a permit until signed by the
Building ollicial or hisitier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
—
F�ICIAL- _�NATU DATE
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RELEASED,BY D
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ATTENT(ON
ITIS UNLAWFULTO USEOR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- OR , IGINAL FILE YELLOW - INSPECTOR
I
FANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK-OAN_ER,,- 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 ................. z
0
Retaining Wall ...........
M
Slab Insulation ..........
PLUMBING: =n-
Underground .............
M
C
Rough -In ................... M
0
0
0
Commercial Final ...... C:
M
HEATING: M z
Gas Test .................... C:
z
-4
Gas Piping .................
Cn
0
Equipment .................
_n
—1
Commercial Final .......
M M
EXTERIOR SHEATHING
NAILING .......................... 0
0 M
C co
FRAMING ........................ Cn
M 0
FIRST FLOOR FRAMING ... Z r-
INSULATION ................... ;0
Floor Insulation .........
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Wall Insulation ...........
Ceiling Insulation ....... CD
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ... 0
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MISCELLANEOUS ..........
FINAL APPROVAL FOR 115
OCCUPANCY ..................