20040869.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAMEINAME OF BUSINESS
T
A a A) go �j V'Art,,p
MAILING ADDRESS
LI>8611 *7
CITY ZIP TELEPHONE
? -76
L
NAME
r6
ss
o
CITY
e__
ZIP
NAME er—
I I A
ADDRESS
CITY ZIP
pe 1 15 3
STATE LICENSE NUMBER
�[ - I at>r
TTELEPHON1
TELEPHONE
3: 0- ;� cmtf.
10 Gf 3
DRdPERTY TAX ACQQUNT
PARCEL NO.
01 0
NEW
RESIDENTIAL
ADDITION
COMMERCIAL
REMODEL
MULTIFAMILY
Zf"REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAININGWALL
ROCKERY
(TYPE OF USE, BUSINESS ORhCTIVIM.qPLA[N
I VjI\ J1,111. j
U)
NNIJER OF CRITICAL
w NUMBER
a OF DWELLING AR
M 17, UNITS NU
o STORIES
DESCRIBE WORK TO BE DONE
l AM
0q;
I
C, I- I I PERMIT EXPIRES
u0c r=r`HV1I I Z,
u8
Z
ZONE
E
q
NUMBER
J JOB SUITE/APT#
of�
S
ADDRESS co
F E
?, 0 Aw Lo
,tADD
PLAT NAME/SUBDIVISION NO.
LOT NO.
LID NO.
_
MRrJkW/_�'. LjA"_1
T
LID FEE S
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
EXISTING — PROPOSED
Street Use Permit Roq'd
Inspection Required
Sidewalk Requited
REQUIRED DEDICATION— FT
R OU IRI
Underground
Wiring required
M T R
METER SIZE
LINE SIZE
NO. OF FIXTURES
PAV REQUIRED
I
I
YEsEl NO 1:1
Li A � I -L
/-CRE<kEi� 13Y
PLUMBING it MECH
COMPLIANCE OR
USE
CHANGE OF
SIGN
FENCE
I X FT)
OTHER
FIRE SPRINKLER
FIRE ALARM
�I 1\1 % 4VtJ 5, �
HEAT SOURCE - I ' GLAZ�NG % I j LOT SLOPE %
PLAN CHECK NO: 1� I I j 1. j I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: ISO DAYS
PERMIT LIMIT., 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) *APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFN� 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 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.'
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 Cq)�PANSATION INSURANCE AND RCW 18.27.
SIGNATURE (OtNER)OR AGENT) DATE SIGNED
REMARKS
OWN ERICON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED BY DATE
FIRE REVIEWED BY DATE
OR CU
0__� I
SEPA REVIEW
COMPLETE , EXEMPT
EXP 14--w
LOT COVERAGE
ALLOWE D OSED
PARKING
REO'D I PROVIDED
REMARKS
SHORELINE OR ADB# INSPECTION I BOND
�OVrI REO POSTED
_12YES
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
uj
z
z
E5
z
W
REQUIRED SETBACKS (FT.) PROPOSED SET13ACKS ( -) I
FRONT SIDE REAR FRONT UR SIDE REVR 0
z
LOT AREA I PLANNING REVIEWED BY DATE CL
.-V L'It It) An AL
CHECKED BY ITYPE OF CONSTRUCTION OCCUPANT
GROU�Le�?2
-TArz;m
I CODE
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/ IBC109/IRC109 FINAL INSPECTION REO'D
-A
VALUATION
Iq 1) U I
Descrlb'tion
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapeinsp.
Recording Fee
I �h
FEE
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Amt. Due
ILL —
Receipt # zx)- /Ipz. I
APPLICATION APPROVAL
I his 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.
amr.la(IR qIGNATkJ1AE DATE
RELEASED
A17ENTIPN t:A I I jjj
ITIS UNLAW�61_TO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- G"
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110- PIN
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
IX14 I
CALL
FOR INSPECTION
(425)
771-0220
FILE
/ *,/k /
L /A?
GOLD -ASSESSOR
I/
z
0
M
-4 -n
0 M
C
M
0
C-)
0 C:
--i K
M M
M Z
01
C
CD
0 -n
n
M M
055
0 r-
0 M
C cf)
9 1:11)
M C-)
Z
z
Cn
z
0
i
0
M
1�
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
..........
z
0
Retaining Wall ...........
--I
0
Slab Insulation ..........
M
PLUMBING:
-n
--I
Underground .............
3:.
ITI
Rough -In ...................
M 0
0
0
0
Commercial Final ......
C
HEATING:
3: M
M Z
10-1
Gas Test ....................
C
Gas Piping .................
Equipment .................
o -n
_n
Commercial Final .......
x
M M
EXTERIOR SHEATHING
0-0)
NAILING ..........................
0
0 ITI
FRAMING ........................
C/)
Cl)
M 0
FIRST FLOOR FRAMING ...
Z
INSULATION ...................
;U
Floor Insulation .........
x
>
z
Wall Insulation ...........
--I
3:
Ceiling Insulation .......
z
SHEETROCK NAILING ...
0
SPECIAL INSPECTION ...
0
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR
C) _tX
OCCUPANCY ..................
Lj 'Cl FOCT