20040925.pdfDATE RECEIVED PERMIT EXPIRES
U E PERMIT
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CITY OF EDMONDS NUMBER
CONSTRUCTION PERMIT APPLICATION JOB SUITEIAPT#
ADDRESS A
0 NER NAME/NAME OF BUSINESS EDMO;40-5 ReAU 15<
PLAT NAME/SUBDIVISION NO LOT NO. LID NO.
5 MAILING ADDRESS 244-, —jtxs1p_)e, .11 LID FEE S
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3: PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP iESCP Approved 0
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3b RW Permit Firiquaird 13
A Ve Street use Permit Arict'd 0
CITY ZIP TELEPHONE EXISTING — PROPOSED Inspection Required 0
sidewalk Required CI
REQUIRED DEDICATION— Ff underground
7) —L L) (D Witing required C3
—1 NO. OF FIXTURES PRV REQUIRED
NAME METER SIZE LINE SIZE
17
I I YES El No El
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t: ADDRESS REMARKS z
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OWNER/CONTRACIOR RESPONSIBLE FOR EROSION CONTROUDRAINAGE 5
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CITY ZIP TELEPHONE
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STATE LICENSE NUMBER EXPIRATION DATE C)4fCKED,BY REQO POSTED
Yps 171KIr) I S
D AW . I -
W SEPA REVIEW SIGN AREA HEIGHT
< PROPERTY TAX ACCOUNT PARCEL NO. COMPLETE , EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
LLI ODO C1> I L EXP
NEW RESIDENTIAL ALLOWED PROPOSED FRONT SIDE REAR FRONT URSIDE REAR
D PLUMBING / MECH LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (FF)
COMPLIANCE OR z
ADDITION COMMERCIAL z
CHANGE OF USE z
PARKING LOT AREA PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN REO'D PROVIDED
GRADING E] FENCE
REPAIR CYDS X Fr) REMARKS
DEMOLISH TANK OTHER
GARAGE o RETAINING WALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
CHECKED BY TYP5 OF CONSTRUCTION 0 Opf OCCUPANT
15 GROUP
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Lu NUMBER �UMBEFI OF CRITICAL
to OF DWELLING AREAS SPECIAL INSPECTION JAREA OCCUPANT
o STORIES UNITS NUMBER REQUIRED LOAD
DESCRIBE WORK TO BE DONE
REMARKS
.PROGRESS INSPECTIONS PER UBC 108/FINAL INSPECTION REO'D z
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130L) Ta. I Q M FmD4 - 0 art :�, 4- Description FEE Description FEE
Plan Check State Surcharge
URCE GLAZING % LOT SLOPE %
Building Permit City Surcharge
I
CK NO: VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE Grading
zi
t.- SEPARATE PERMISSION.
Cr Engr. Review
LU PERMIT APPLICWFION: 180 DAYS
PERMIT LIMIT: 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
(n
UJI 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 Fire Inspection Receipt #
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 CIry ORDINANCE Landscapelnsp. Total Amt. Due
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION."
Recording Fee Receipt #
EREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION THAT THE INFORMATION
GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE OU& AUTHORIZED AGENT OF APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a permit 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 VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt is acknowledged in space provided.
WORKMEN'S COMPENSAT!qrs ANCE AND RCW 18.27. OFFICIALS SIGNATURE DA�TE
__T_ 1_ (425)
SIGN '6TU �NEFI 00 DATE IED -M - 0 0 V,
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10 L � 1 0 Lt
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1 771-0220 LE 13Y DAT
ATTENTION E)ff 1333 _2
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFI- ORIGINAL - FILE YELLOW - INSPECTOR
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK - OWNER GOLD - ASSESSOR
091103 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
z
0
Pier/Porch .................
0
Retaining Wall ...........
M
Slab Insulation ..........
--I
PLUMBING:
x
M
Underground .............
M 0
0
0
Rough -In ...................
C
M
Commercial Final ......
M Z
HEATING:
C
Gas Test ....................
Gas Piping .................
0 -n
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Equipment .................
M M
Commercial Final .......
0
0
EXTERIOR SHEATHING
0 in
C C1)
NAILING ....... ..................
C 0)
Q 0
FRAMING ........................
Z
FIRST FLOOR FRAMING ...
;U
INSULATION ...................
>
z
Floor Insulation .........
Wall Insulation ...........
z
Ceiling Insulation .......
0
SHEETROCK NAILING ...
0
M
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
10
24