20040934.pdfDAIE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NA M NAME OF BUSINESS
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MAIL ING ADDRESS
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CITY, ZIP TELEPHONE
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NAME
ADDRESS
CITY
ZIP ITELEPHONE
NAMEr CEIL h
ADDRESS
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CITY I ZIP ,,ITELEPHONE
STATE LICENSE NUMBER EXPIRATION DATE C
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PROPERTY TAX, ACCOUNT PARCEL NO
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Pq IFIESIDENTIAL
LUMBING / MECH
A?C-OMPLIANCE
ADDITION
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COMMERCIAL
08
CHANGE OF USE
REMODEL
MULTIFAMILY
SIGN
1EPAIR
GRADING
CYDS
FENCE
( — X FTJ
DEMOLISH
TANK
OTHER
GARAGE
rARPORT
RETAINING WALL
ROCKERY
FIRE SPRINKLER
FIRE ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER NUMBER OF CRITICAL
OF I I DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
G
HEAT SOURCE I GLAZING % I LOT SLOPE %
PLAN CHECK NO: I VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
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
IN INTEREST, AGREES TO INDEMNIFY. DEFEND AND HOLD HARMLESS THE CITY OF
EDMONDS, WASHINGTON. ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND
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 CITY ORDINANCE
NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
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
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED
I A
IN VIOLATIQN�OF THE LAqOFLCODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'$ COM PE NSATION/)USU RANCE AM RCW 18.27.
NT)
PLAT NAME]SUBDIVISION NO
PERMIT EXPIRES
PERMIT
NUMBER
I
5kig
LOT NO.
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
EXISTING — PROPOSED
REQUIRED DEDICATION— FT
METER SIZE LINE SIZE NO. OF FIXTURES
SUITE/APT#
, 1"�u
LID NO.
LID FEE $
7FZ77=��
TESCP App'ov'
0
13
SW p,,,,l Rqui,ld
stroot uso Pormit Raci'd
[3
inspoction Requilad
13
Sld,walk Requit0d
[3
underground
[3
Winng faquired _
pRV REQUIRED
YES [3 NO 0
REMARKS
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
ENGINEERING REVIEWED
DATE
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UA
F �W.EVkb W fl�j DATE
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on ffiel-burning appliances passing
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INUTUA-eLiF -SHOREL114EOR
BOND
AEQ'D POSTED
1=1 OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE I EXEMPT ALLOWED , PROPOSED ALLOWED PROPOSED
EXP 1�
LOT COVERAG� REQUIRED SETBACKS (FT) PROPOSED SETBACKS (FT)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING ED rLOT AREA I PLANNING REVIEWED BY DATE
REO'D I PROVID
REMARKS
CHECKED BY ITYPEMCMT TIfN
SPECIAL INSPECTION JAREA OCCUPANT
LOAD
REQUIRED [] YES
REMARKS z
[,P,'ROGRESS INSPECTIONS PER UBC 108 IBC109/ IRC109 FINAL INSPECTION REO'D 1 2J5
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscape Insp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt N
Total Amt. Due
Receipt # ZV'
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
FFICIALS SIGNATURI� I t DATE
I 11&110("�_ A/6
RELEASED
ATTENTION V RE UNTILARNAL
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTU
INSPECTION HAS BEEN MADE AND APPROVAL OR ACERTIFICATE OF OCCU- ORIGINAL -FILE YELLOW -INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/1BC110/lRC110. PINK -OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
DATE SIGNED
CALL
FOR INSPECTION
(425)
771-0220
13
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.... .... .. ....... ... .
.... . ..... . . .
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS ... * ....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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Retaining Wall ........... 0
Slab Insulation .......... 0
M
PLUMBING:
Underground .............
ITI
Rough -In ................... C
M
0
Commercial Final ...... 0
0 C
HEATING: 3: 1711
ITI z
Gas Test ....................
> z
Gas Piping ................. -4
x
CD
Equipment .................
0
Commercial Final .......
EXTERIOR SHEATHING M ITI
NAILING .......................... 0-0)
0
FRAMING ........................ 0 171
0)
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
Floor Insulation .........
3:
Wall Insulation ........... z
--I
Ceiling Insulation .......
Cn
SHEETROCK NAILING ... z
0
I
SPECIAL INSPECTION ... 0
171
ds,
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
0 f3il k0000,W
The Initials MT are Milton
Thompson, a temporary contract
-or the City.
inspector f