20041081.pdfI
DATE RECEIVED
PERMITEXPIRES
U Sit- PERMIT
70NE
L
CITY OF EDMONDS NUMBER
JOB SUITEIAPT#
CONSTRUCTION PERMIT APPLICATION ADDRESS
OWNER NAMUNAME OF BUSINESS 8203 182nd Pl SW
Dwight Young PLAT NAME/SUBDIVISION NO LOT NO LID NO.
LID FEE $
LM MAILING ADDRESS
U I FSCP Approved
z PUBLIC RIGHT OF WAY PER OFFICIAL STREET MAP RW Permit NOCItilf6d E3
3r 8203 132nd Pl SW Street Use Permit port'd 0
0 inspection noqusied E3
CITY ZIP TELEPHONE EXISTING - PROPOSED Sidewalk Required 0
Undelgro,tind
Edmonds 98026J 425-774-1509 REQUIRED DEDICATION- FF - wiring required 0
NAME METER SIZE LINE SIZE NO. OF FIXTURE PRV REOLIRED
Y S t
I I ES 0 NO 13
t: ADDRESS REMARKS
x OWNERICONTRACTOR RESPONS113LE FOR EROSION CONTROUDRAINAGE
lij
CITY ZIP JTELEPHONE
Jype B or L vent connectors required
NAME 1 un file! -burning appilances pAssing
ENGI
FAst Water Heater IMF11 10�V:110
V ADDRESS
12601 132 Ave NE
TELE PHONE
__T _ 1
CITY ZIP TELEPHONE
Kirkland 98034 425-81431:24
STATE LICENSE NUMBER EXPIRATION DATE
PA.qTWRC0c;2DF 2-16-05
PROPERTY TAX ACCOUNT PARCEL NO.
00643700000900
NEW
RESIDENTIAL
12
ADDITION
1:1
REMODEL
MULTIFAMILY
1:1
REPAIR
GRADING CYDS
DEMOLISH
TANK
GARAGE
CARPORT
RETAINING WALL
ROCKERY
(TYPE OF USE, BUSjQESS OR ACTIVITY) EXPLAIN:
Lu NUMBER NUMBER OF
DWELLING
UNITS
OF
0 STORI
DESCRIBE WORK TO BE DONE
closet davl
HEAT SOURCE
PLAN CHECK NO:
FIRE REVIEWED BY
DATE
I/ IVARIANCE On CU SHORELINE OR ADBI I INSPECTION I BOND
BY REO'D POSTED
I OYES ONO S
PLUMBING / MECH
COMPLIANCE OR
OF USE
CHANGE
SIGN
FENCE
( X FT,
OTHER
FIRE SPRINKLER
FIRE ALARM
CRITICAL
AREAS
NUMBER
t basement 38,000 btu's
GLAZING %
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: 1110 DAYS
PERMIT LIMIT. I YEAR - PROVIDED WORK IS STARTED WITHIN 180 DAYS
SEE BACK OF PINK PERMIT FOR MORE INFORMATION
OAPPLICANT. 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 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 CITYS ABILITY TO ENFORCE ANY ORDINANCE PROVISION.'
EHEREBY ACKN'
'VEN IS CORF
HE OWNER I
ION - AND IN D
VIOL 0 1
OWLEDGE THAT I HAVE READ THIS APPLICATION; THAT THE INFORMATION
I HEREBY ACKN R THE DULY AUTHORIZED AGENT OF
GIVEN IS CORRECT: AND THAT I AM THE OWNER, 0
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.
Sl TUR (0� I DATE SIGNED
SIGNATURE (OVI�ER OR
SEPA REVIEW
COMPLETE I EXEMPT
EXP
LOT COVERAGE
ALLOWED PROPOSED
PARKING
REQ'D I PROVIDED
REMARKS
CHECKED BY ITYPE
SPECIAL INSPECTIC
REQUIRED [] YES
REMARKS
VALUATION
$ 449.
Description
Plan Check
Building Permit
Plumbing
Mechanical
Grading
Engr. Review
Engr. Inspection
Fire Review
Fire Inspection
Landscapelnsp.
Recording Fee
SIGN AREA HEIGHT
ALLOWED . PROPOSED I ALLOWED , PROPOSED
REQUIRED SETBACKS (FT) PROPOSED SETBACKS (IFT.)
FRONT SIDE REAR I FRONT UR SIDE REAR
LOT AREA I PLANNING REVIEWED BY
AREA
CALL
FOR INSPECTION
(425)
771-0220
n to tne req
DATE
OCCUPANT
GROUP
OCCUPANT
LOAD
State Surcharge
City Surcharge zt:
lvv� Base Fee
uj
z
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F3
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uj
tu
Ir
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Plan Chk. Deposit
Receipt #
Total Amt. Due
Receipt #
APPLIC ION APPROVAL
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.
F OF S 71G /AIU R E DATE
ELEASED BY KATE
ATTENTION t:)k I I
IT IS UNLAWFULTO USE OR OCCU PYA BUILDING OR STRUCTURE UNTILA FINAL
INSPECTION HAS BEEN MADE AND APPROVAL ORA CERTIFICATE OF OCCU-
PANCY HAS BEEN GRANTED. UBC109/IBC110/lRC110-
09/03 PRESS HARD -YOU ARE MAKING 4 COPIES
ORIGINAL -FILE YELLOW -INSPECTOR
PINK -OWNER GOLD -ASSESSOR
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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 ...
0 t4
M o S_
MISCELLANEOUS ..........
FINAL APPROVAL FOR
0
OCCUPANCY ..................
0 / W1100040,0 ;,
The Initials MT are Milton
Thompson, a temporary contract
inspector for the City.