20040989.pdfDATE RECEIVED 4�- PERMITEXPIRES (dlk
USE PERMIT
CITY OF EDMONDS ZONE NUMBER
CONSTRUCTION PERMIT APPLICATION
OWNER NAME/NAME OF BUSINESS
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MAILING ADDRESS
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CITY ZIP TELEPHONE
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NAME
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CITY ZIP ITELEPHONE
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ADDRESS
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CITY ZIP TELEPHONE —1
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ADDRESS 7
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PLAT NAME/SLIBDIVISION No.
OT NO.
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LID NO.
LID FEE S
TESCIR Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
RW Permit Required
[3
Street Use Permit Hoq'd
EXISTING PROPOSED
Inspection RaquIrad
Sidewalk Required
E3
REQUIRED DEDICATION—
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Underground
Wiringfoquired
E3
METER SIZE
LINE SIZE
OF FIXTURES
PRV REQUIRED
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YES 13 NO
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REMARKS
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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BY DATE
FIRE REVIEWED BY DATE
VARIANCE OR CU SHORELINE OR ADBN INSPECTION 7ON D
STATE LICENSE NUMBER EXPIRATION DATE
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CHECKED BY
REO'D
10YES ONO
POSTED
IS
SEPA REVIEW
COMPLETE , EXEMPT
EXP
SIGN AREA
ALLOWED PROPOSED
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HEIGHT
ALLOWED , PROPOSED
7ROPERTY TAX ACCOUNT PARCEL NO.
MeV014-3
NEW
ADDITION
RESIDENTIAL
09
COMMERCIAL
PLUMBING / MECH
COMPLIANCE OR
CHANGE OF USE
LOT COVERAGE
ALLOWED PROPOSED
REQUIRED SETBACKS (Fr.)
FRONT SIDE REAR
PROPOSED SETBACKS (Fr.)
FRONT URSIDE REAR
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE 5
REMODEL MULTIFAMILY [3 SIGN R.EQ'D I PROVIDED
GRADING FENCE X FT) REMARKS
REPAIR ryng 1:1
OTHER
DEMOLISH TANK 1:1
EiGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY 11 FIRE ALARM
(TYPE OF USE, BUSINESS OR 41CTIVITY) EXPLAIN: HECKED BY ITYPE OF CONSTRUCTION OCCUPANT
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NUMBER NUMBER OF CRITICAL IV14
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0 F DWELLING AREAS LOAD
STORI S UNITS NUMBER REQUIRED [] YES
DESCRIBE WORK TO BE DONE .
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PROGRESS INSPECTIONS PER UBC 108/IBC1091IRC109 FINALINSPECTION REO'D
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VALUATION
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Plan Check State Surcharge
HEAT SP413CE G G % LOT jQ01QPE %
Building Permit City Surcharge
PLAN CHECK NO: VESTED DA Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
tZ BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
a DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
A SEPARATE PERMISSION.
Engr. Review
PERMIT APPILICATION: 180 DAYS
a. PERMIT LIMIT! I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
q 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 # Z_5592�
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
DEEMED TO MODIFX WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
Recording Fee Receipt #
I HERE13Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION APPLICATION APPROVAL
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_ This application is not a permit until signed by the
TION; AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED CALL Building Official or his1hor 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 C DATE
_9MEQNSATION INSURANCE AND RCW 18.27.
OFFICIALa S
JGNATURE
SIGNATU NER AGENT) DATE SIGNED (425)
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LCA �JA
771-0220 RELEA BY DATE
ATTENTION EXT 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL 11A _/
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU- ORIGI A - FILE - YELL�N ASPECTOIR
PANCY HAS BEEN GRANTED. UBCj 09 / IBC1 10 / IRCI 10. PIN - OWNER GOLD -ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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RECORD OF INSPECTIONS
INSPECTOR
DATE APPROVED
SE TBACKS ..................... 1.
FOUNDATION:
Footing .......... ...........
Wall...........................
Pier/Porch .................
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0
Retaining Wall ...........
0
Slab Insulation ..........
PLUMBING:
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Underground .............
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Rough -in ...................
0
0. 0
Commercial Final ......
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HEATING:
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Gas Test ....................
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Gas Piping ..................
3:
Equipment .................
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Commercial Final .......
3:
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EXTERIOR SHEATHING
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NAILING ..........................
0 M
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FRAMING .. ........ ............
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FIRST FLOOR FRAMING...
INSULATION ...................
Floor Insulation .........
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Wall Insulation ...........
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Celling Insulation .......
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SHEETROCK NAILING ...
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SPECIAL INSPECTION ...
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MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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