20040998.pdfI
DATE RECEIVED PERMIT EXPIRES
USE PERMIT
CITY OF EDMONDS ZONE NUMBER,
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OPER NA /NAME OF BUSINESS onsmummmon�
C PLAT NAME/SUBDIVISION"NO LOT NO, LID NO.
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M MAILING ADDRESS LID FEE S
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z TESCP Approved 0
3: /07 PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Hoqkjlfod 13
0 Lyn Street use Permit Roq'd 0
CITY TELEPHONE EXISTING — PROPOSED inspection Required 13
Sidewalk Required 0
REQUIRED DEDICATION— FT Underground
P;� 0 �//�/ — Wiring tortueed 0
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
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STATE LICENSE NUMBER EXPIRATION DATE CHECKED BY REO'D POSTED
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L�0—�5 - SEPA REVIEW SIGN AREA HEIGHT
-4j( PROPERTY TAX ACCOUNT PARCEL NO. L;UMVl_t=iE I EXEMPT ALLOWED PROPOSED ALLOWED PROPOSED
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LOT COVERAGE REQUIRED SETBACKS (FT.) PROPOSED SETBACKS (Fr.)
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REMODEL ULTIFAMILY SIGN RED PARKING D LOT AREA PLANNING REVIEWED BY DATE
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REPAIR X—M CYDS x ( X FT) REMARKS
DEMOLISH TANK OTHER
GARAGE RETAININGWALL FIRE SPRINKLER
z CARPORT ROCKERY FIRE ALARM
(TYPE OF USE, BUSINESS OR Ac"TIVITY) EXPLAIN:
CHECKED BY ITYPUF CONSTRUCTION C ME OCCUPANT
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a OF DWELLING AREAS SPECIALIN�P CTION JAREA OCCUPANT
0 UNITS NUMBER REQUIRED LOAD
- STORIES iYES
DESCRIBE WORK TO BE DONE
REMARKS
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PROGRESS INSPECTIONS PER UBC 108/[BC109/IRC109 FINAL INSPECTION REO'D
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VALUATION
$
Description FEE Description FEE
Plan Check State Surcharge
OURCE GLAZING % LOT SLOPE % Building Permit City Surcharge
ECK VESTED DATE Plumbing Base Be
fill--5 11 1 — Mechanical
'HI1 WORK NOTED. THIS PERMIT COVE C) c),
THIS PERMIT AUTHORIZES ONLY T RS WORK TO
I= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS. DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
PERMIT APPLICATION: 180 DAYS
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PERMIT LIMIT. 1 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 — 7
2 EDMONDS, WASHINGTON, ITS OFFICIALS, EMPLOYEES. AND AGENTS FROM ANY AND Fire Inspection Receipt #
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ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT BE Landscapelnsp. Total Amt. Due
DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENI OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY THE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION *
MI Recording Fee Receipt H
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 APPLICATION APPROVAL
THE OWNER. I AGREE TO COMPLY WITH CITY AND STATE LAWS REGULATING CONSTRUC- CALL This application is not a perinit until signed by the
1ION AND IN DOING THE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building Official or his/her Deputy: and Fees are paid, and
IN V61-ATION OF THE LA13OR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION feceipt is acknowledged in space provided.
WORKMEN'S COMPENSATION INSURANCE AND RCW 18 27.
1-1 16 OFFICIA,��7. NA DATE
Sr�TURE (OWNE� 0 ENr) D D (425)
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ATTENTION E)ff 1333 ZJ 7 / Q'
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IT IS UNLAWFULTO USE OR OCCUPYA BUILDING OR STRUCTURE UNTILA FINAL #
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�ImAL FILE: YELLOW
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU . INS4LC-Y6
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110. PINK - OWNER COLD - 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 .................
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
OCCUPANCY ..................
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