20040901.pdfI
DATE RECEIVED PERMIT EXPIRES . T_T_ -7 1
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
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OWNER NAME/NAME OF BUSINESS
PLAT NAMEISUBDIVISION NO. LOT NO. LID NO.
MAILING ADDRESS LID FEE S
I ESCP Approved 13
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required 13
Street use Permit Roq'd 13
EXISTING - PROPOSED Inspection Required
CITY ZIP TELEPHONE Sidewalk Required
1 underground
?t�c) 1�oaQ �G 71 REQUIRED DEDICATION- Fr Wiring required E3
NAME METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YES 0 NO 13
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REMARKS z
ADDRESS OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 3
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CITY ZIP TELEPHONE
NAME
6e_r)ese,,P_ _I ENGINEERING REVIEWED BY DATE
ADDRESS
r C� too FIRE REVIEWED BY DATE ILIA
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CITY" ZIP TELEPHONE
0
VARIANCE OR CU SHORELINEORADBI INSPECTION B7ND
STATE LICENSE NUMBER E X P I ��T I� NDTA-T E CHEE Y REO'D POSTED
OYES ONO
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G 3 70D 4q::�D sEPA REVIEW SIGN AREA HEIGHT
PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE EXEMPT ALLOWED , PROPOSED ALLOWED P110POSED
Lu D
o EXP
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW ESIDENTIAL PLUMBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LJR SIDE REAR
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COMPLIANCE OR z
OMMERCIAL z
ADDITION rc b CHANGE OF USE
)IMA "imd DATE
ARKING
REMODEL MULTIFAMILY SIGN It"1311 U Ipp"MPM
1:1 1:1 9 Applia �ices passing
FENCE ro I 1p;,j
REPAIR GRADING CYDS 1:1 U 8 Z03. 2]
X Fr) REMARKS` I M
OTHER
TANK
DEMOLISH 11 0
GARAGE c RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY 13 FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN: CHECKED BY TYPE 0 ONS' ODE� OCCUPANT
GROUP
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RE �5 701
NUMBER NUMBER OF CRITICAL Ll OCCUPANT
AREAS SPECIAL INSPECTION JAREA
OF DWELLING , / ly LOAD
STORIES UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE (31 i
REMARKS I
PROGRESS INSPECTIONS PER UBC 108/ ISC109/IRC109 FINAL INSPECTION REO'D
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VALUATION
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Description
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Plan Check
HEAT SOURCE GLAZING %
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LOT SLOPE %
Building Permit
PLAN CHECK NO: VESTED DATE
Plumbing
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
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: 180DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
Fire Review
IN INTEREST AGREES TO INDEMNIFY, DEFEND AND HOLD HARMIESS IHE CIFY OF
EDMONDS, I�ASHINGTON. ITS OFFICIALS. EMPLOYEES. AND AGEN IS FROM ANY AND
Fire Inspection
ALI. CLAIMS FOR DAMAGES OFWHATEVER NATURE, ARISING DIRECHY Oil INDIRECTLY
FROM THE ISSUANCE OF rHIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT 13E
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DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR I IMIT IN ANY WAY THE CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION'
Recording ee
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
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THE OWNER. I AGRiE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSIRJUC
r) CALL
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
IN VIOLATION OF THE LABOR CODE OF rHE STATE OF WASHINGTON RELATING TO FOR INSPECTIO
WORKMEN'S COMP URANCE AND RCW 18 27.
�50JATION,
SIGNATURE low R 6A WAG" DATE SIGNED (42,1
771-02
20
FEE
Description FEE
State Surcharge
City Surcharge 1__1 �1�
Base Fee
Plan Chk. Deposit
Receipt 0
Total Amt. Due
Receipt #
APPLICATION APPROVAL
I ius application is riot a perrind until signed by the
Building oiticrai or tus/irer Deputy. and Foes are paid, and
fecuipt is acknowledged in space provided.
VIA 'bS G��l U1
A17ENTION r.,& I I
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU.
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC11U.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
BY I I DA
ORIGINAL - FILE YELLOW - INSPECTOR
PINK OWNEH 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 ....................
Cbmt-herci al final ......
HEATING:
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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The illiti',Ils wr are miltoll
Tiloillpson, a telliporary contract
illspector for tile CitY.
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