20040877.pdfDATE RECEIVED Z
[PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEINAME OF BUSINESS ,t P
C) t t),_-t CJ PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
LCC MAILING ADDRESS LID FEE $
u
z P TESCP Approved
3.
0 7 ��D V1 5 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required E3
Street Use Permit Roq'd 13
EXISTING - PF30POSED inspection Required [3
CITY ZIP TELEPHONE Sianwalk Required C3
1 Underground
IV2_4�:- REQUIRED DEDICATION- FT Wring required 13
r bZc
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES 13 NO z
z
lo- ADDRESS REMARKS z
x OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE 33
L) z
cc W
cc
CITY LEPHONE
ype B or L vrent connectors require(71
NAME CBL OnTil—CT-.-t)t.iriiitigal)pii2tces pRgsiltig
I If 1� __ - 1� � . -
ENGINEERild btl I I t.-H-t7m N P A ces. I.Wi 803.2
Ice ADDRESS
0
DATE W
FIRE REVIEWED BY M
C I ZIP TELEPHONE M
0
U -7
BOND
VARIANCE OR CU SHORELINE OR ADBI INSPECTION I
STATE LNENSE NUMBER EXPIRATION DATE CHECKED BY REQO POSTED
Cdl OYES 131`40 S
SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE XEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
00743 N tifgiir) 6.7 CX-10 EXP
LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (FT.)
F1 NEW X RESIDENTIAL PLUMBIN(A�CH ALLOWED PROPOSED FRONT SIDE BEAR FRONT URSIDE REAR
ADDITION COMMERCIAL COMPLIANCE OR
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL El MULTIFAMILY SIGN REO'D I PROVIDED
FENCE
REPAIR GRADING CYDS ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE E] RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE. BUSINESS OR ACTIVITY) PLAIN: CHECKED BY ITYP OF ONSTRUPTION OCCUPAL.,
GROUP
0
U)
NUMBER NUMBER OF CRITICAL OCCUPANT
OF DWELLING AREAS SPECIALINSPEC ON AREA LOAD
M UNITS NUMBER REQUIRED S
0 STORIE��Jlf YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINALINSPECTION REO'D
12,4A el 0 VALUATION
Ono 6,Lbt $
6 61-4r- Descriptio n— FEE Description FEE
Plan Check State Surcharge
GLAZI NG % LOT SLOPE %
HEAT SOU
-If _jE Building Permit City Surcharge
PI AN ACHECK NO: VESTED DATE Plumbing Base Fee
THIS PERMI AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO Mechanical 4
t= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 160DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 100 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
Lo 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
U)
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 #
ir ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIREC1LY
X FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF IIIIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
x:I NOR LIMIT IN ANY WAY I HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.' Recording Fee Receipt #
4/1
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION, THAT THE INFORMATION APPLICATION APPROVAL
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 CALL I his application is riot a pennit until signed by the
TION AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN V61LATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION- .:1 fecoiplisacknowledgedin space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27. 0 F 11 1. S��N 13E DAT,/
DATE.�
A rLEAS�b BY zk//
siq�A�#E (OWNER /R G ED (4 05)
7� 6/a/ 4
771-0220 R- A
AiTEN"TION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPY A BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU- OF41GINAL FILE YELLOW - INSPECI Oil
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK -OWNER GOLD-ASSESSon
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
z
0
i
0
M
1.
=i =5
0 M
C:
M 0
0
--1 0
0 C:
M
M Z
0-4
_z
3:
Cn
o -n
n
M M
0 _Cf)
0 r_
0 M
C (1)
F, U)
M 0
Z
z
-i
X
Cn
z
0
M
01
I
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ..........................
FOUNDATION:
Footing.........................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
-InRough ...................
Commercial Final ......
HEATING:
GasTest ....................
GasPiping .................
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
OCCUPANCY ..................
�OY(77
z
0
1
0
M
—i -n
0 M
M 0
0
__10
0 C
3: M
M z
3:
0 -n
n
M M
0
0
0 M
cl)
(n
M 0
Z
z
--I
3:
Cn
z
0
1
0
171