20040960.pdfDATE RECEIVED PERMIT EXPIRES
I USE PERMIT
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CITY OF EDMONDS NUMBER C)q
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS 07 — 7
OWNER NAME/NAME OF BUSINE S _7
;Bey- 0 /1 PLAT NAME/SUBDIVISION NO. LOT NO. LID NO.
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MAILING ADDRESS LID FEE $
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BI: I PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP f3w Permit Required (3
0 q6 7 -7 9 At/ /W Street Use Permit Roq'd E3
inspection Required [3
CITY ZIP TELEPHONE EXISTING - PROPOSED Sidewalk Required [3
REQUIRED DEDICATION- FT Underground
2 6", 14�� `7 761- S 4/ winng required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PAV REQUIRED
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YES No cc
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I= ADDRESS REMARKS z
x OWNERICONTRACIOR RESPONSIBLE FOR EROSION CONIROLIDRAINAGE
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CITY ZIP TELEPHONE
NAME CBL$1
417j_ /Z�v 1171 A6/ �1 ENGINEERING REVIEWED BY DATE
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FIRE REVIEWED BY DATE uj
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ITY ZIP TELEPHONE iz
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//owcrw VARIANCE OR CLI SHORELINE OR ADBI INSPECTION IS 13OND
7K) S11r LICENSE N_UMj3ER EXPIRPTION 9ATE I IE REO'D POSTED
I (11P; VF 12,10 o JA . M I DYES ONO
W q11 �PY17 SEPA REVIEW SIGN AREA HEIGHT
-<j PROPERTY TAX ACCOUNT PARCEL NO. I IF COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
(3
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C2 0 0 EXP
0' LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW );Z"'RESIDENTIAL MBING MECH ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
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IANCE OR z
ADDITION COMMERCIAL El CHANGF OF USE z
PARKING LOT AREA NNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY SIGN DED CL
GRADING FENCE
REPAIR El CYDS ( X Fr) REMARKS
DEMOLISH TANK OTHER
oGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
(rYPE OF USE, BUSINESS OR IVJP� IN:
CHECKED BY ITY: Con OCCUPANT
GROUP
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NUMBER NUMBER OF CRITICAL /V/
/(j� OCCUPANT
OF DWELLING AREAS SPECIAL INSPECT104 JAREA LOAD
0 STORIES UNITS NUMBER REQUIRED
DESCRIBE WORK TO BE DONE I a
REMARKS z
PROGRESS INSPECTIONS PER ILIBC 108/IBC109/IRC109 FINALINSPECTION REO'D 9
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
HEAT SOURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
PLAN CHECKJWIL_� VESTED DATE Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
t: BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
9 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180DAYS
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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 Plan Chk. Deposit
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt 0
ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERMIT SHALL NOT BE Landscapelnsp. Total Amt. Due
_9 DEEMED TO MODIFY, WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.-
- ----- Recording Fee Receipt # /7c�u
'TP'PLICATION APPROVAL
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- CALL This application is nut a pounit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Olficial or his/her Deputy: and Fees are paid, and
IN VIOLAT!;P;04�THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION receipt Is acknowledged in space provided.
WORKMEN C Mo SATION INSURANCE AND RCW 18.27. OF_ELG_1A1_ T
I DATE
19 ATUR QWNER SAN T) SIGNED (425) 1_,s,7i1V, IVl,— i llxz, z�,
771 -022
0 RELliASFDLI3Y [�TE7
ATTENTION EXT 1333
ITIS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE ANDAPPROVALOR ACERTIFICATE OF OCCU- ORIGINAL -FILE YELLCW- 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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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
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0
Retaining Wall ...........
0
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Slab Insulation ..........
PLUMBING:
Underground ............. 3:
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Rough -In ................... Ll C 0
ITI 0
Commercial Final ...... 0 C
3: M
HEATING: ITI Z
ID --I
Gas Test ..................... C z
Gas Piping .............. 3:
Equipment ................. 0 -n
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Commercial Final ....... --i
3:9
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EXTERIOR SHEATHING 0 5
NAILING .......................... 0
0 ITI
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FRAMING ........................ 0)
Q 0
FIRST FLOOR FRAMING ... Z r-
INSULATION ................... ;U
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Floor Insulation ......... :E
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Wall Insulation ...........
Ceiling Insulation ....... Cl)
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SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
The Initials MT arc Milton
Thompson, a temporary contract
inspector for the City.