20040888.pdf"I DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAPAE Op BUSINESS
MAILING ADDRESS
CITY ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP I TELEPHONE
NAME
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STATE LICENSE NUMBER EXPIRAJION DATE
CHECKED BY
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PROPERTY TAX ACCOUNT PARCEL NO.
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NEW 2� RESIDENTIAL
.9/FILUMBING I MECH
ADDITION COMMERCIAL
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COMPLIANCE OR
CHANGE OF USE
E] REMODEL APARTMENT
SIGN
�REPAIR GRADING
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FENCE
( X FT)
DEMOLISH TANK
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CARPORT ROCKFRY
RENEWAL
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(TYPE OF USE. BUSINES�V� ACTIVITY) EXPLAIN:
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NUMBER rNUMBE . ROF
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STORIES UNITS
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NUMBER
DESCRIBE WORK TO BE DONE
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RCE I GLAZING �. I LOT SLOPE .,,,
PLAN CHECK NO: JVESTFD DAI E
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
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SEPARATE PERMISSION.
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LU PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT: I 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
En
w IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
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M EDMONDS, WASHINGTON, ITS OFFICIALS. EMPLOYEES AND AGENTS FROM ANY AND
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECT LY OR INDIREC TLY
FROM THE ISSUANCE OF I HIS PERMIT ISSUANCE OF THIS FERMI I SHALL NOT BE
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_j DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREVENT OF ANYCITY OHDINANCE
01 NORLINI)TINANYWAYTHECITY'SAIIILIT-� To E N FORCE AN,,' OR DINANC., E P HOVI F11 ON
I HEREBY ACKNOWLEDGE THAI IHAVE PEADTHISAPPLICATION, THAT IFIF %FORVAT10%
GIVEN IS CORREC1. AND THAT I AM THE OWNER OR rHF DWy AUTHOPIZED AGENT
THEOWNER I AGREE TO COMPLY WITH CIIYI�ND STATE LA'NS REGUI-AIING CONSTHUC
I ION. AND IN DOING THE WORK AUTI'OFAIZED 1HEREW, NOPFRSONV�KLF ' E f: %11, 1 0', i 1)
IN VIOLATION OF THE LA13OR CODE oF THE 1,;IATE OV WAcHINGTO'.
WORKMEN S COMPE-NSATiON IN',,LJRANL:E ANP;4�A*1' lil
AGFNTr PAN �;16%; (I
SIGNATURE iOWN
PERMIT EXPIRES
PERMIT
N U M B E f PI<A4,
'10 [3 SUIT
ADDRE 9'3
PLAT NAMFISUPE)IVIC�ION NO, LOT NO LID NO,
LID FEE S
TESCP Approved 0
�UBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 0
Street Use Permit Rod d 0
EXISTING - PROPOSED Inspection Required 0
Sldewal� Acquired 0
REQUIRED DEDICATION- FT Underground
I Wiring tecluired C)
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED C3
I I I YES 0 NO 0 9
REMARKS
OWNER/CON TRACTOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE
In addition to the reauii
pressure/relief valve, an
ENC31N ;listed Vansion tank sh
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DATEI LU
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VARIANCE OR CU
SHORELINE OR ADB#
INSPECTION
BOND
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YES 0 NO
SEPA REVIEW
SIGN AREA
HEIGHT
COMPLETE EXEMPT
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ALLOWED PROPOSED
ALLOWED PROPOSED
EXP I
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,
LOT COVERAGE
REQUIRED SETBACKS (FT.)
PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT UR SIDE REAR
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PARKING
LOT AREA
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I PLANNING REVIEWED BY DATE
REO'D I PROVIDED
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ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI-
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109
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CHECKEDBY ITYP
SPECIAL INSPECTOR JAREA
REQUIRED [:] YES I
GROUP,,�
OCCUPANT
LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REQ'D
VALUATION FEE
PLAN CHECK FEE
BUILDING
PLUMBING
MECHANICAL
GRADING/FILL.
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ENG %VIF�V F;-:r-5
ENG INSPFCTION FEE
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INSPEC HON FEE
PLAN DiECK DEPOSIT I RECEIPT
TC)TAL AV0LJ%T DLIF
APPLICATION APPROVAL
This irplic,jtion -S ncit cl 130trT111 Until Sign0d bv ji-,
CALL andFLLsr1TeINi1d ina
FOR INSPECTION f0,_.0 in sp,jca I)t0vidod
0' IC LS SIGNA U' t: DAT E
(425)
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EXT 333
-1771-0221
ORIGINAL - FILE YELLOW - INSPECTOR
FAX PINK OWNER GOLD - ASSESSOR
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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:
-7
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
OCCUPANCY ..................
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