20040973.pdfI
DATE RECEIVED
ERMIT EXPIRES
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I IUSE PERMIT
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C1W OF EDMONDS NIJMEIER'�()�)
CONSTRUCTION PERMIT APPLICATION JOB ITE/APT#
ADDRESS,
OWNER NAME/NAME OF BUSINESS _��T NO,
_L1kf.A,v\ 41A41A PLAT NAME/SUBDIVISION LID NO.
um MAILING ADDRESS LID FEE $
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PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required
0 0 Yli-Y fl� /.2 / Street Use Permit Roq'd E3
EXISTING - PROPOSED inspection Required E3
CITY j zip TELEPHONE sidewalk Required E3
REQUIRED DEDICATION- FT Underground
;r:-d)),W4A I wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
YES NO
E ADDRESS REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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city TELEPHONE
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61)(1Q1611,141 I . ENGINEERING REVIEWED BY DATE
ADDRESS
CITY
STATE LICENSE NUMBER
NEW
ADDITION
AREMODEL
REPAIR
DEMOLISH
GARAGE
CARPORT
(TYPE OF IASE, I
RESIDENTIAL
IOMMERCIAL
%CULTIFAMILY
MM
GRADING CYDS
TANK
FIETAININGWALL
ROCKERY
NESS 05 ACTIVIM EXPLAIN:
NUMBER NUMBER OF
OF DWELLING
STORIES UNITS
DESCRIBE WORK TO BE DONE
HEAT SOURCE I GLAZING %
PLAN CHECK NO:
E
CHECKED BY
PLUMBING(!� �CH
COMPLIANCE OR
El CHANGE OF USE
SIGN
FENCE
( X FI)
OTHER
FIRE SPRINKLER
FIRE ALARM
FIRE REVIEWED BY
DATE
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VARIANCE OR CU HORELINE OR AD1111 I INSPECTION I BOND
REO'D POSTED
OYES ONO S
SEPA REVIEW SIGN AREA HEIGHT
COMPLETE , EXEMPT ALLOWED , PROPOSED ALLOWED , PROPOSED
EXP
LOT COVERAGE REQUIRED SETBACKS (FT) PROPOSED SETBACKS (Fr.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT UR SIDE REAR
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PARKING LOT AREA I PLANNING REVIEWED 13Y DATE :5
REDD I PROVIDED I CL
REMARKS
CHECKED BY ITYPE OF CONSTRUCTION
CODE OCCUPANT
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GROUP
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CRITICAL
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AREAS
SPECIAL INSPECT16N AREA
OCCUPANT
NUMBER
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LOAD
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/
IRC109 FINAL INSPECTION REQ1D
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LOT SLOPE %
VESTED DATE
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THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
It= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
2 DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
D SEPARATE PERMISSION.
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cc PERMIT APPLICATION: 180DAYS
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PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
On @APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
2 EDMONDS. WASHINGTON. ITS OFFICIALS, EMPLOYEES, AND AGENTS FROM ANY AND
cc ALI. CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
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X FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
D DEEMED TO MODIFY WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
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kI I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
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GIVEN IS CORRECT; AND THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF
IV IS
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THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC-
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TION ' AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED
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IN V61-ATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO
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W I M
'S COMPENSA��RANCE AND RCW 18,27.
WORKMEN ,
S I of TU E
SIGNATURE (OWNER O#GEN DATE SIGNED
VALUATION
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
FEE Description FEE
State Surcharge
City Surcharge
Base Fee
No
Plan Chk. Deposit
Receipt
Total Amt. Due
Receipt ft
APPLICATION APPROVAL
This application is not a permit until signed by the
Building Official or his/tier Deputy: and Fees are paid, and
receipt is acknowledged in space provided.
OFFICIALS SIGNATURE
AA
RELEASED BY
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBCI09/IBC110/lRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
CALL
FOR INSPECTION
(425)
771-0220
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REALTY ALL.COM
REALTY com Commercial Residelillial / investment / Financing
www.realtyall.coni
1220 SO 356*n's,r. C-4 FEDERAL WAY, WA 98003 OFFICE 253-874-9624 FAX 253-943-5390
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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 .................
Commercial Final .......
EXTERIOR SHEATHING
NAILING .......... ...............
FRAMING ........................
FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
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OCCUPANCY ..................
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