20040868.pdfI
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PERMIT EXPIRES .-It';
IF
USE PERMIT
CITY OF EDMONDS ZONE NUMBER C
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS ""d6`
.& 00� 0
OWNER NAME/NAME OF BUSINESS �?,ok& Aw
" Tka r,,J 6po- r, Liiilvoe X6L -OAv+vL, PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
1x MAILING ADDRESS LID FEE $
W E3
z TESCP Approved
PUBLIC RIC14T OF WAY PER OFFICIAL STREET MAP RW Permit Required
10� LA 714AIr LAJ O-S Street Use Permit Roq'd [3
CITY EXISTING — PROPOSED Inspec6on Required C3
ZIP TELEPHONE Sidewalk Required [3
dLN -LS- PL I? REQUIRED DEDICATION— FT Underground
VwW '0 Wiringirequirod E3
NPE METER SIZE LINE SIZE NO. OF FIXTU"RES PRV REQUIRED 0
S I
YES NO z
13 Sc� r o e- &jt uj
z
E ADDRESS REMARKS z
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
(3
gr Ave I to 1z W
CITY ZIP TEL'111111111 I
14
NAME CBL #1
T/ k I ENGINEERING REVIEWED BY DATE
a: ADDRESS
0
5 FIRE REVIEWED BY DATE W
CITY ZIP TELEPHONE M
VARIANCE OR CU SHORELINE OR ADB# INSPECTION BOND
STATE LICENSE NUMBER EXPIRATION PATE REO'glr POSTED
9 Y OYES AU110 S
Ly 6 1 D'I L- '7 (k)� b�'? SEPA REVIEW SIGN AREA — HEIGHT
-j PROPERTY TAX A�qCURARC L Ng COMPLETE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
W
EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIR SIDE REAR
COMPLIANCE OR z
ADDITION COMMERCIAL 2
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED By DATE 15
ROODEL 0-MILTIFAMILY SIGN REO'D I PROVIDED
FENCE fuueif� 10
GRADING—' 104,
i"REPAIR 13 r. Y Dq ID X Fr) REMARKS
DEMOLISH 1-1 TANK OTHER
GARAGE Ei RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS n IV
��EXPLAIN:
CHECKED BY ITYPE QEXTRUCTION CODE OCCUPANT
GROUP
At, 12023 )92
NUM13ER NUMBER OF CRITICAL
OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
M LOAD
0 STORIES UNITS NUMBER REQUIRED [:] YES
DESCRIBE WORK TO BE DONE
REMARKS z
]PROGRESS INSPECTIONS PER UBC 108/ IBC109/IRC1D9 FINAL INSPECTION REQ'D
I A M
11.4
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A NJ 41114t( IV,
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HEAT SOURCE I GLAZING% LOT SLOPE %
PLAN CHECK NO: j I I i j j I 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 (CURDS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180DAYS
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 1HIS 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 PROVISIOW'
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM Tl IE OWNER. OR T1 iE 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 C9
,�JR�NSATION INSURANCE AND RCW 18.27.
SIGNATURE NER R AGENT) DATE SIGNED
I AA,.- 6 -(�q
VALUATION
$
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp..
Recording Fee
Z
V 4
FEE Description FEE
0 State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt #
L
Total Amt. Due
Receipt #
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.
RELEASED
ATTENYION E)ff 1333
IT IS UNLAWFULTO, USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL
I NSP ECTI ON HAS BEEN MADE AN D APPROVAL OR A C ERTI FICATE OF OCCU -
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
CALL
FOR INSPECTION
(425)
771-0220
NAL - ILE YELLOW - INSPEMOR
nWNr. GOLD - ASSESSOR
mr
-?K - MNER
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1
0
M
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M
C:
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0
10
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0 M
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M 0
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0
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ITI
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ..............
z
--Pie0orch .................
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
M
Underground .............
M
--I 0
Rough -In ...................
C)
0 C
Commercial Final ......
M
M z
HEATING:
C z
--j
Gas Test ....................
Gas Piping .................
0 _n
Equipment.................
M
Commercial Final .......
IT!
—cn
EXTERIOR SHEATHING
0
0 171
NAILING ..........................
C: 0
Cn
FRAMING ........................
M 0
Z
FIRST FLOOR FRAMING...
X
INSULATION ...................
--I
x
Floor Insulation .........
z
--I
Wall Insulation ...........
3:
Cn
Ceiling Insulation .......
z
0
SHEETROCK NAILING ...
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................