20041050.pdfI "e" -
DATE RECEIVED
/,�- � I ,,, PERMIT EXPIRES
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USE PERMIT
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CITY OF EDMONDS NUMBERf
JOB SUITE/APT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMEIN7AME-;O:FBUSINESS zi
IT 7 NO. LID NO,
PLAT NAME/SUBDIVISION
1 8 SS
u A17L NG A D F LID FEE S
E
7ESCP Approved
PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit Required [3
Street use Permit Roqd [3
inspection Required 0
C . ITY ZIP TELEPHONE EXISTING - PROPOSED Sidewalk Required 13
Underground
REQUIRE[) DEDICATION— Fr — Wiring i C3
NAME METER SIZE LINE SIZE NO. OF FIXTURES PRV REQUIRED 0
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YES NO E3 rr
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ADDRESS REMARKS z
OWN E R/CON TRACTOR RESPONSIBLE FOR EROSION CONTROL/DRAINAGE
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CITY ZTP TELEPHONE
NAME CBL#
06 DATE
76. i?) ENGINEERING REVIEWED BY
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CITY ZIP TdEPHONE
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U61("'I kI .,. I .�/) �51� -V /— — - -_ VARIANCE OR CU SHORELINE OR ADS# INSPECTION BOND
FIATf LICENSE NUMBER E RAT19N DATE I ,4qECKNDVY 0Y REQO POSTED
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SIGN AREA HEIGHT
SEPA REVIEW
COMPLETE E)K ALLO PROPOSED ALLO�ED PpOPREDb
PROPERTY TAX ACCOUNT PARCEL NO. td
LU 6_j r EXP I
LOT COVERAGE REQUIRED SETBACKS (Fr.) PROPOSED SETBACKS (Fr.)
NEW RESIDENTIAL El PLUMBING MECH ALLOWED PROPOSED FRONT S E REAR FRONT URSIDE REAR
COMPLIANCE OR 6�
ADDITION COMMERCIAL CHANGE OF USE z
PARKING LOT AREA LA W a CL
REMODEL MULTIFAMILY REO'D I PROVIDED IP 0 Rw 'E
SIGN
GRADING _41ENCE
REPAIR CYDS ( __4� x -J� FT) REMARKS%/
1:1 DEMOLISH El TANK OTHER
GARAGE RETAINING WALL FIRE SPRINKLER
CARPORT ROCKERY El FIRE ALARM
0
(TYPE OF USE. BUSINESS OR ACTIVITY) EXPLAIN: CHECKED TYPE qfCONSTRUCTION CODE OCCUPANT�,
GROUP
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By
w NUMBER NUMBER OF CRITICAL OCCUPANT
a OF DWELLING AREAS SPECIAL. INSPECTIF��R�A
to UNITS NUMBER REQUIRED [] LOAD
0 STORIES /6, YES
DESCRIBE WORK TO BE DONE
REMARKS z
PROGRESS INSPECTIONS PER UBC 1081FINAL INSPECTION REQ1D
to
VALUATION
$
Description FEE Description FEE
HEAT SO GLAZING % LOT SLOPE % Plan Check State Surcharge
/.L. Atj I -- / 7/� -_ Building Permit City Surcharge
PLAN CHECK NO: VESTED DATE/ Plumbing Base Fee
Mechanical
THIS PERMIT AUTHORIZES ONLY THE WORK NOTED. THIS PERMIT COVERS WORK TO
BE DONE ON PRIVATE PROPERTY ONLY. ANY CONSTRUCTION ON THE PUBLIC Grading
DOMAIN (CURBS, SIDEWALKS, DRIVEWAYS, MARQUEES, ETC.) WILL REQUIRE
SEPARATE PERMISSION.
Engr. Review
2--
Cc PERMIT APPLICATION: 180 DAYS
or
PERMIT LIMIT I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS Engr. Inspection
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
(n 'APPLICANT. ON BEHALF OF [its OR HER SPOUSE, HEIRS, ASSIGNS AND SUCCESORS Fire Review Plan Chk. Deposit
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 #
a: ALL CLAIMS FOR DAMAGES OF WHATEVER NATURE, ARISING DIRECTLY OR INDIRECTLY
It SSUANCE OF THIS PERMIT ISSUANCE OF THIS PERM11 SHALL NOT BE
* FROM THE I Landscapelnsp. Total Amt. Due
* DEEMED TO MODIFY. WAIVE OR REDUCE ANY REQUIREMENT OF ANY CITY ORDINANCE
0 NOR LIMIT IN ANY WAY I HE CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION. -
Recording Fee Receipt IV
I it E13Y A NOWL DGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
RECT No THAT I AM THE OWNER, OR THE DULY AUTHORIZED AGENT OF APPLICATION APPROVAL
S TO COMPLY WITH CITY AND STATE LAWS REGU This application is not a permit until signed by the
C JAGR CALL
TH �WINE LATING CONSTRUC
OING IE WORK AUTHORIZED THEREBY. NO PERSON WILL BE EMPLOYED Building 011icial or his/her Deputy: and Foes are Paid, and
TIO NDI Do" receipt is acknowledged in space provided.
IN V TIO OF TH LABOR CODE OF THE STATE OF WASHINGTON RELATING TO FOR INSPECTION
WEIR i�`S QMPEN ION INSURANCE AND RCW 18 27.
OFFICIA"IGNAWRE DATE
DATE SI ED
NER OrMtj�
P, -0220 L7F11
(425)
771 T /I DAT
ATTEN ION EXT 1333
IT IS UNLAWFUL TO USE OR OIJUMPY A BUILDING OR STRUCTURE UNTIL
FIL
A FINAL INSPECTION HAS BE ADE AND APPROVAL OR A CER1IFI ORIGINAL E YELLOW IN�PEC4R
CATE OF OCCUPANCY HAS BEEN GRANTED. UBC SECTION 109 PINK -OWNER GOLD -ASSESSOR
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RECORD OF INSPECTIONS
INSPECTOR DATE APPROVED
SETBACKS .....................
FOUNDATION:
Footing ......................
Wall..........................
Pier/Porch ................. z
0
Retaining Wall ...........
Slab Insulation ..........
PLUMBING:
Underground .............
M
C
Rough -In ................... M
0
0
Commercial Final ...... 0 C
HEATING: M
M Z
Gas Test .................... C
>
F_
Gas Piping .................
Equipment ................. 0 -n
-n
Commercial Final .......
M M
EXTERIOR SHEATHING
0
NAILING .......................... 0
0 M
FRAMING ........................ Cn
Cn
Q 0
FIRST FLOOR FRAMING ... Z
INSULATION ................... ;U
_11
Floor Insulation .........
z
Wall Insulation : ..........
Ceiling Insulation .......
Cn
z
SHEETROCK NAILING ... 0
SPECIAL INSPECTION ...
M
MISCELLANEOUS ..........
FINAL APPROVAL FOR 0_3
OCCUPANCY ..................
zo
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