20040994.pdfFDATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
ER NAME/NAME OF BUSINESS
121-12 /04
P`ERMIT
NUMBER
j\\Y)tetr0 Cft�XLLLKC
0C I MAILING ADDRESS
u
z �—Aj
0
CITY ZIP I TELEPHONE
NAME
ADDRESS
-A
AhOI�ESS
C\wo
CITY ZIP TELEPHONE
I Lto 41 kvF2z - V
CV:�ID 13 __1 l-,jrqT,
STATE LICENSE NUMBER EX
PROPERTY TAX ACCOUNT -PARCEL NO,
�D ' )L
E]
NEW
RESIDENTIAL
El
COMMERCIAL
ADDITION
1:1
MIXED USE
REMODEL
MULTIFAMILY
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
El
RETAINING WALL
CARPORT
ROCKERY
(TYPE OF USE, BUSINESS OR ACTIVITY) E,)�PL_AIbL;/
:0
L �IMB�IN IQ �cw
F�
COMPLIANCE OR
CHANGE OF USE
F�
SIGN
0
FENCE
( X FT.)
OTHER
FIRE SPRINKLER
FIREALARM
JOB
ADDRESS
k - - I _.- %__
7AT NAME!SUBDIVIS'=ONNO
PERMIT EXPIRES ((i I /-I
. Y)t LE�
SUITE.iAPTO
z_h11fl1(
LOT NO LID NO
LID FEE S
T15CPA r 0
,
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP
pp"
Pwn A k, ,
(3
EXISTING PROPOSED
in%;,w N,n
REQUIRED DEDICATION FT
undef jww"j
0
M
_N65F FIV�R`FS
' Ne RF(julm:D
k
NO 13
z
ix
ul
REMTRKQ� -A
iiCSv�ON!�
W
z
OWN[ RK^-T4TAc'T6R SIBL'� F0�4jAAFAWn0I.,DRAINAQI7
[5
z
L
012 F110-511511lig 50)
It
ENGINEFRMtHRE WEY901"tx:J
FIRE REVIEWED BY
CAT E
ui
0:
P. AQ D
NUMBER NUMBER OF
OF C
DWELLING
STORIES UNITS t
DESCRIBE WOkK TO BE DONE
") 1 )/ 0) / )M /V, �hlj<,
ho"lluli'vi'v 4711 Npn(,V� R7W�_l
HEAT SOURCE
LOTSLOPE%
VESTED DATE
PLAN CHECK NO:
THIS FERMI RIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBIC
DONMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES. ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: SEE ECDC 19.00.005(A)(5)
PERMIT LIMIT: SEE ECDC 19.00.005(A)(6)
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
*APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESSORS
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 CITY'S ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
VARIANCE 06
ft�hVrELI��iqR 6DB# INSPECTION I SEPA
rk INT
a raw �]
LFTFD FxEmpt
CA0 A r rZMA V I I%) 415WAIEiA I HEIGHT
WAIVER En " Pf _`LD ALLOO,LD
H i cffrTl
STUDY 13 1 1 1, FPPII� I I P�'OPOSED
LOT COVERAGE REQUIRED SETBACKS (FT) I PROPOSED SETBACKS (FT.)
ALLOWED PROPOSED FRONT SIDE REAR FRONT LIRSIDE REAR
z
j 0.
PARKING LOTAREA PLANNING REVIEWED By DATE 5
REQ'D . PROVIDED 1z
REMARKS
SPECIAL INSPECTIO
REQUIRED 13YES
BY'
STI
BY:
Description
OCCUPANT
GROUP
CONSULTANT
OCCUPANT
LOAD
FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
Plan Chk. Deposit
Receipt #
Total Anit. Due
Receipt #
I HEREBY 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 This application is not a permit until signt�d by the
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL Building Official or his/her Deputy and Feesate Paid,anfj
TION; AND IN DOING THE WORK AUTHORIZED THEREBY, NO PERSON WILL BE EMPLOYED receipt is acknowledged in space p(ovided
IN VIOLATION OF THE LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WORKMEN'S COMPENSA RANCE AND RCW 18:27. 1 nFrjCJA S SIGNATI.IRE . A I DATE I
147ATURE (OWNER O� —L. - DATE SIGNED (425)
NT):
77
1 m0220 RELEASED
EXT. 1333
ATTENTION
IT IS UNLAWFUL TO USE OR OCCUPY A BUILDING OR STRUCTURE UNTIL
A FINAL INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTI-
FICATE OF OCCUPANCY HAS BEEN GRANTED. UBC109 / IBC110 I IRC110.
110104 PRESS HARD - YOU ARE MAKING 4 COPIES
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
LandscapeInsp.
Recording Fee
E
ORIGINAL - FILE YELLOW - INSPECTOR
PINK -OWNER GOLD - ASSESSOR
z
0
1
0
M
--I -n
0 M
C
M 0
0
C-)
0 C:
-4 K
X M
M z
rL.) -1
C: -Z
o -n
n
M M
0
0
0 M
C U)
9 CD
M C-)
Z
7'
X
z
--A
X
Cn
z
0
M
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
S&BACK� ...... .............
FOUNDATION:
Footing .... : ..................
Wall... .......................
Pier/Porch .................
z
0
Retaining Wall ...........
0
Slab Insulation .......... M
PLUMBING: =n-
Underground .............
M
Rough -In ................... C 0
ITI 0
-1 C)
Commercial Final ...... 0 C
--I K
HEATING: M M
M Z
Gas Test ....................
> z
Gas Piping ................. r
Cn
Equipment .................
0 _n
Commercial Final .......
EXTERIOR SHEATHING M ITI
0
NAILING .......................... 5;
0 r-
0 M
FRAMING ........................ C (n
C/)
FIRST FLOOR FRAMING ... Q 0
Z
INSULATION ...................
Floor Insulation .........
>
Wall Insulation ........... z
Ceiling Insulation ....... C/)
z
SHEETROCK NAILING ... 0
I
SPECIAL INSPECTION ... 0
171
MISCELLANEOUS ..........
FINAL APPROVAL FOR -14 �S;
OCCUPANCY ..................
&000000,