20041011.pdf'. 11111111
DATE RECEIVED
CITY OF EDMONDS
CONSTRUCTION PERMIT APPLICATION
CVNER NAMEINAME OF BUSINESS
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MAILING ADDRESS
'72,(
CITY ZIP TELEPHONE
77"537 11/1
NAME
ADDRESS
CITY
NAME
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STATE LICENSE NUMBER
ZIP I TELEPHONE
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PERMIT EXPIRES 1:�4(4; -L-
dSE PERMIT
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JOB SUITE,`APT#
ADDRESS 2
PLAT NAME/SUBDIVISION NO. LOT NO, LID NO,
LID FEE $
TESCP APPrOv6d
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required
Street Use Permit Rpq'd [3
EXISTING - PROPOSED Inspection Required [3
Sidewalk Required C3
REQUIRED DEDICATION- FT underground
Wiring required E3
METER SIZE LINE SIZE NO, OF FIXTURES PRV REQUIRED
YESM NO 13
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LREMARKS
OW R/C
OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROLIDRAINAGE
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; q Sr=::L V I / 421 ENGINEERING REVIEWED BY DATE
Lc Ave_ (-J FIRE REVIEWED BY DATE onso�
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VARIANCE OR CU SHORELINEORADB# I INSPECTION BOND
EXPIRATION DATE CHEWED BY RE.Q'D POSTED
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PROPERTY TAX ACCOUNT PARCEL NO.
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12,7 0 3 2� a 0 24 (0
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F1 NEW ' RESIDENTIAL X—PLUMBING
ADDITION COMMERCIAL COMPLIANCE OR
E] CHANGE OF USE
REMODEL MULTIFAMILY SIGN
GRADING FENCE
El REPAIR 11 f-YnS I X FT)
[:] DEMOLISH TANK OTHER
Ei GARAGE RETAINING WALL FIRE SPRINKLER
FIRE
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CARPORT ROCKERY ALARM
(TYPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
NUMBER
NU E OF
CRITICAL
OF
DWEBLLIRNG
AREAS
0
STORIES
NUMBER
DESCRIBE WORK TO 13E DONE
�3r_q a_'q I- U3 I 5�"VW170.
HE,4j SO�YE GLAZING % LOT SLOPE %
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U., -It%,l% VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
1= BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
W PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT 1 YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
U) 'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
M IN INTEREST, AGREES TO INDEMNIFY, DEFEND AND HOLD HARMLESS THE CITY OF
M 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 REOUIREMENTOF ANY CITY ORDINANCE
0 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 COMPENSATION INSURANCE AND RCW 18.27.
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SIGNATURE (OW.JE =0G1 11"n NE
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Ft I DATE Sl
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IE]YES
ONO
I S
SEPA REVIEW
SIG AREA
HEIGHT
COMPLETE E EMPT
ALLOWED PROPOSED
ALLOWED PROPOSED
EXP ,
I
LOT COVERAGE
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (FT)
ALLOWED PROPOSED
FRONT SIDE REAR
FRONT L/R SIDE REAR
0
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PARKING
LOT AREA
PLANNING REVIEWED BY DATE
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REO'D I PROVIDED I
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REMARKS
CHECKED BY ITYPE TRt,JCTIO CO E OCCUPAI�T k?
)7 GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED LOAD
REMARKS z
PROGRESS INSPECTIONS PER UBC 108/IBC109/IRC109 FINAL INSPECTION REQ'D
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr, Inspection
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FEE Description
State Surcharge
City Surcharge
Base Fee
FEE
I
Fire Review Plan Chk. Deposit
Fire Inspection Receipt #
Landscapelnsp. Total Amt. Due
Recording Fee Receipt #
APPLICATION APPROVAL
This application is not a permit until signed by the
CALL Building Official or his/tier Deputy: and Fees are paid, and
FOR INSPECTION receipt is acknowledged in space provided.
� WIN URE DATE
(425) 11 4
771-0220 RELEASED BY "/DA
AtTENTION 1; E)ff 1333
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL
INSPECTION HAS BEEN MADE AND APPROVALOR A CERTIFICATE OF OCCU- ORIGINAL - FILE YELLOW - INSPECTOR
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRCIIO. PINK - OWNER GOLD - ASSESSOR
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
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11
RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall ..........................
Pier/Porch .................
Retaining Wall ...........
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0
Slab Insulation ..........
0
PLUMBING:
Underground ............. =i 9
Rough -In ...................
0 M
C
Commercial Final ...... M 0
0
0
HEATING: 0 C
M
Gas Test .................... M z
Gas Piping ................. C _Z
Equipment ................. x
Commercial Final ....... 0 -n
EXTERIOR SHEATHING
NAILING .......................... MIT!
0
FRAMING ........................ 0
0 ITI
C
FIRST FLOOR FRAMING ... Cn
9 C/)
Q 0
INSULATION ................... Z
-A
Floor Insulation .........
Wall Insulation ...........
>
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Ceiling Insulation .......
--I
SHEETROCK NAILING ... Cn
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SPECIAL INSPECTION ... 0
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0
1711
MISCELLANEOUS ..........
FINAL APPROVAL FOR 3 .05
OCCUPANCY ..................
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The Illitials NIT are N/liltol,
Thompson, a temporary Contract
inspector ror tile City.