20041040.pdfI
DATE RECEIVED
[PERhMITEXPIRES
USE PERMIT
CITY OF EDMONDS ZONE
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAME/NAME OF BUSINESS t1j.-I ��yd
r- /-L M PLAT NAMEiSUBDIVISION NO. 'LO T IN 0. LIO NO.
MAILING ADDRESS LID FEE $
TESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP AW Permit Required E3
7v� Street Use Permit Roq'd
CITY Z16 TELEPHONE EXISTING — PROPOSED inspection Required
Sidewalk Required
REQUIRED DEDICATION— FT Underground
F vf� Wiring required 13
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED
0
YES13 NO K
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OWNER/CONTRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE 8
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CITY ZIP TELEPHONE
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STATE �ICENSE NUM R EXPIRATION DATE DBY
PROPERTY TAX If
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NEW RESIDENTIAL E] PLUMEING i MECH
ADDITION COMMERCIAL COMPLIANCE OR
1:1 CHANGE OF USE
REMODEL MULTIFAMILY SIGN
AREPAIR GRADING FENCE
CYDS El ( X FT)
E] DEMOLISH E] TANK F-1 OTHER
EiGARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY FIRE ALARM
MPE OF USE, BUSINESS OR ACTIVITY) EXPLAIN:
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NUMBER NUMBER OF CRITICAL
OF DWELLING AREAS
STORIES UNITS NUMBER
DESCRIBE WORK TO BE DONE
0 L F,
GLAZING %
PLAN CHECK NO:
LOT SLOPE %
VESTED DATE
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
PERMIT APPLICATION: 180 DAYS
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
'APPLICANT, ON BEHALF OF HIS OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS
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 DIRECTIY OR INDIRECTLY
FROM THE ISSUANCE OF THIS PERMIT. ISSUANCE OF THIS PERMIT SHALL NOT BE
DEEMED TO MODIF'� WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
NOR LIMIT IN ANY WAYTHE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.0
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.
SIGNATURE (OWNp7,0R AGENT) DATE SIGNED
ENGINEERING REVIEWED BY
FIRE REVIEWED BY
VARIANCE OR CU
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SEPA REVIEW
COMPLETE EXEMPT
EXP I X
LOT COVERAGE
ALLOWED PROPOSED
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PARKING
REO'D I PROVIDED
REMARKS
DATE
DATE
SHORELINE OR ADBI
INSPECTION
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REO'D
PBOND
OSTED
OYES
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SIGN AREA
HEIGHT
ALLOWED PROPOSED
ALLOWED PROPOSED
2- G - I I La , 6 .5
REQUIRED SETBACKS (Fr.)
PROPOSED SETBACKS (Fr.)
FRONT SIDE REAR
FRONT LJR SI E REAR
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[PLANNING REVIEWED BY DATE
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CHECKEDBY ITYPE OF CONSTRUCTION
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GROUP
SPECIAL INSPECTION JAREA OCCUPANT
REQUIRED [] YES LOAD
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PROGRESS INSPECTIONS PER UBC 108/ IBC109/ IRC109 FINAL INSPECTION RECI'D -
VALUATION
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Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
CALL
FOR INSPECTION
(425)
771-0220
FEE Description FEE
r__75 State Surcharge . 61
City Surcharge
Base Fee
Plan Chk. Deposit
Receipt # 21 3r4-�2
Total Amt. Due
Receipt #
APPLICA7 )ROVAI
This application is not a permit until signed by the
Building Official or his/her Deputy: and Fees are paid. and
receipt is acknowledged in space provided.
7FIFtALS SIGNATURE ATE
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ATTENTION EXT 1333 1 '/(/
IT IS UNLAWFULTO USE OR OCCUPYABUILDING OR STRUCTURE UNTILAFINAL L—Z.
INSPECTION HAS BEEN MADE AND APPROVAL OR A CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/IRC110.
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL - FILE YELLOW - INSPECTO
PINK -OWNER GOLD -ASSESSOR
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IF THE DOCUMENT IN THIS FRAME IS LESS CLEAR THAN THIS NOTICE
IT IS DUE TO THE QUALITY OF THE DOCUMENT.
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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 ..........................
A/)
FRAMING ..R.O& ..........
FIRST FLOOR FRAMING ...
INSULATION ...................
Floor Insulation .........
Wall Insulation ...........
Ceiling Insulation .......
SHEETROCK NAILING ...
SPECIAL INSPECTION ...
MISCELLANEOUS ..........
FINAL APPROVAL FOR
OCCUPANCY ..................
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The Initials NIT are Miltoll
Thompson, a temporary contract
illSI)Cctol- for tile City.
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