20040889.pdfDATE RECEIVED PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/N pt
AME OF BUSINESS
M11 IVA_ PAL A k) 6 t_'A N1 L U PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
M MAILING ADDRESS LID FEE $
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z IESCP Approved
31 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Roclirited
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CITY ZIP TELEPHONE EXISTING PROP
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QUIRED DEPICATJON '10"
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NAME ETN _911E LINE SIZE Nd. OFCDQU�ES V A REQUIRED
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EPHONE In addition to the required W
CITY peuswureirelief valve, an approved
NAME CBL# listed expansion tank shall be
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Unstnille t water taflk_v.
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STATE LICENSE NUMBER EXPIRATION DATE CHECK till BOND
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C�X Ile-`16 kjH 0 1 SEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
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NEW RESIDENTIAL PLUMBING MECH LOT cou - t ME4LrR'W SMUR kFTY I -PROPOSED SETBACKS (Fr.)
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ADDITION COMMERCIAL ROW
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PARKINGWI AVIAEa P"Mkh MWVkD BY DATE 5
'R71F REMODEL MULTIFAMILY SIGN REO'D I PROVIDED IL
?�_ GRADING FENCE rBE ACOEPTED
1:1 REPAIR CYDS ( X FT) REMARKS
El DEMOLISH 1:1 TANK 1:1 OTHER
Ej GARAGE Ei RETAINING WALL FIRE SPRINKLER
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(TYPE OF USE, BUSINESS OR ACTIVIM EXPLAIN: CHECKED BY TYPE F CONST U TION qD OCCUPANT
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DESCRIBE WORK TO BE DONE
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PROGRESS INSPECTIONS PER UBC 1081IBC109/IRC109 FINAL INSPECTION RECI'D
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Description FEE Description FEE
p6kq, F4t7"___t_ VA#b-(P_ t A�j ek Plan Check State Surcharge
HEAT -SOURCE GLAVING % LOT SLOPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
L 13E DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
SEPARATE PERMISSION.
2 Engr. Review
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W PERMIT APPLICATION: 180DAYS
PERMIT LIMIr I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE. HEIRS. ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
IN INTEREST, AGREES 10 INDEMNIFY. DEFEND AND HOLD HARMLESS THE CIrY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND Fire Inspection Receipt #
ALL CLAIMS FOR DAMAGES OF WHATEVER NAlURE, ARISING DIRECILYOR INDIRECrtY
x FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I [its PERMIT SHALL NOT HE
DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENr OF ANY CITY ORDINANCE Landscapelnsp. Total Amt. Due
0 NOR LIMIT IN ANY WAY THE CITYS ABILRY TO ENFORCE ANY ORDINANCE PROVISION.,
Recording Fee Receipt #
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY W1111 CITY AND STATE LAWS REGULATING CONSTRUC- This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED CALL Building Official or hts/hor Deputy: and Fees are paid. and
IN VIOLATION OF TIRE LABOR CODE OF THE STATE OF WASHINGION RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18.27.
IF I PAS IGNATUR�E,,,,, IATE
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SIGNATURE OWNER OR(t2jN'D,," TE SIGNED (425)
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PKI'a, t4 771-0220 Rj.EASED BY DA — — —
ATTEKTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILARNAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/iRC110. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RAPORD,OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS: .....................
FOUNDATION:
Footing .................
Wall .................
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Pier/Porch .................
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.. ...... . .. Retaining'Wall .� .............
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§5�,lnsulatlon ...........
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Underground .............
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Gas Test ....................
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Gas Piping .................
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Equipment.................
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Commercial Final .......
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EXTERIOR SHEATHING
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NAILING ..........................
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FRAMING ........................
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FIRST FLOOR FRAMING ...
INSULATION ...................
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Floor Insulation .........
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Wall Insulation ...........
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Ceiling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
Tile initials MT are Milton
Thompson, a temporary contract
inspector for the City.