20040964.pdfV
I
Oq 1 .-C c,
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS /rj 77N -
Z 77T.7
MAILING ADDRESS
CITY ZIP TELEPHONE
NAME
7RESS
ZIP
TELEPHONE
NAME 6 ) C1111/01A
& 7S L-5 7 1-4 � �j eo Tt*011,3-
ADDRESS ot)
CITY ZIP TELEPHONE
�O*All),� 2Z,�-2,4o ' _49�4 L
STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY
AoWl'�td 6 6, e/�e/ 11 1 1yo
1263 4�Y05
PROPERTY TAX ACCOUNT PARCEL NO.
00 7714190060. 300
1:1 NEW RESIDENTIAL
El ADDITION COMMERCIAL
El REMODEL MULTIFAMILY
Y—tREPAIR E] GRADING CYDS
1:1 DEMOLISH El TANK
GARAGE o RETAINING WALL
CARPORT ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
i1v Vm - ril
NUMBER NUMBER OF
OF DWELLING
M 1
-3 16
0 STORIES UNITS
1 DESCRIBE ORK TO BE DONE
t,fv% k"
eft- 12,
HEAT SOURCE
GLAZING %
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
SIGN
FENCE
( X FT
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
LOT SLOPE %
PLAN CHECK NO: 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 APPUCATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 100 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 INDIRECT LY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF I HIS 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
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
WORKMEN'S COMPENSATIONJ#�RANCE AND RCW 18,27.
V S TURE (0 R OR JENTIJ DATE SIGNED
hIj 2! �/� ., / /-)
jt- er
I
PERMIT EXPIRES
I
USE PERMIT
ZONE
I
�e L-L
NUMBER
JOB
ADDRESS Lo L /Izl��a
011�
E PT#
/7 7?
PLAT NAME/SUBDIVISION NO. L 0 Q0.
LID NO.
LID FEE $
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
TESCP Approved
RW Permit Required
Street Use Permit Floq'd
EXISTING — PROPOSED
inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT
Underground
Wiring required
METER SIZE
LINE SIZE
NO.
OF FIXTURES
PRV REQUIRED
YES 13 NO 13
REMARKS
OWNERICONTRACTOR RESPONSIBLE FOR EROSION CONTROODRAINAGE
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
DATE
DATE
0
Z
M
uj
z
LU
W
M
rL
VARIANCE OR CU
SHORELINE OQAVDB#,
INSPECTION
BOND
116�4li
"A
REI�_,
YES NO
I S
POSTED
SEPA REVIEW
COMPLETE EXEMPT
EXP
SIW
ALLOWED
AREA
PROPOSED
HEIGHT
ALLOWED PROPOSED
�
LOT COVERAGE
REQUIRED
SETBACKS (FT)
PROPOSED SET BACKS (FT
!L/R 17)
ALLOWED PROPOSED
FRONT
SIDE REAR
FRONT
SID:EREAR
z
A/A
DATE
z
z
PARKING I
REQ'D I PROVIDED
LOT AREA
I P NING REYIEWE9 By
'rz_
REMARKS:)L,jj,r,, —Iq il-t", I
(>A�_ U-e IcLf
MV51 y%-S_6-rCK Q/niiii Y cuto-/,�' 01"L
iJ'0, ly
ecK,
CHECKED BY jfrYP
C7 CODE
�RUCTION OCCUPAN7
GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS
PROGRESS INSPECTIONS PER UBC 108/IBC109/lRC109 FINAL INSPECTION REO'D
to
VALUATION
s 3.
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
ATTENT`ION I=x 1;jjj
IT IS UNLAWFULTO USE OR 00CUPYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
FEE
Description
FEE
State Surcharge
city surcharge
Base Fee
gs�
Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt #
APPLICATION APPROVAL
This application is not a perinit until signed by the
Building Official or his/her Depulyi and Fees are paid, and
receipt is acknowledged in space provided.
:FIQIAL.S-.SIGNATUfJE DATE
* _�SED BY
LE DATE
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINALI(FILE) YELWWINSPEd`TC
PINK-OWNEIR GOLD -ASSESSOR
z
0
i
0
M
-n
M
M
0
--i C)
0 C:
M
M Z
o -n
n
MM
0
0
0 M
Cn
Cn
M
Z
7'
r
z
z
0
A
0
M
I
RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SETBACKS ......................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch .................
Retaining Wall ...........
Slab insulation ..........
PLUMBING:
Underground .............
Rough -In ...................
Commercial Final ......
HEATING:
Gas Test ....................
Gas Piping .................
Equipment .................
Comm�. --:a.
EXTERIOR SHEATHING
NAILING ..........................
VAS
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
14
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
z
0
0
M
0 M
M
0
__10
0
3: M
M Z
C
0 _n
n
171 M
055
0 r-
0 M
C (1)
9 CO)
Q 0
Z
z
3:
z
0
ITI